Age: 8.0
Sex: M
Vaccine: VARCEL
Symptoms: Keratitis, Lethargy, Mydriasis, Nausea, Photophobia
Clinical narrative: It was reported in a published article, title as stated above that an otherwise healthy, 8 year old male, who was active with no history, signs, or symptoms of any immunological problems that would place him at risk for development of herpes zoster opthalmicus at a young age, who, at 1 year of age, was vaccinated with a dose of varicella virus vaccine live. It was reported that the patient was seen by an optometrist for pain and subconjunctival hemorrhage in the right eye. The reporter speculated that the subconjunctival hemorrhage may have been caused by increased vascular fragility in the boys disease state. He was referred to a general ophthalmologist and diagnosed with allergic conjunctivitis and staphylococcal marginal keratitis in his right eye. He was given neomycin polymyxin dexamethasone eye drops, 4 times daily, and referred to a pediatric opthalomologist. On examination, the visual acuity was 20/20 in each eye. His pupils were equal and motility was normal. There was a diffuse subconjunctival hemorrhage and inferior punctate corneal staining in the right eye. The child and his mother were asked if there had been any recent peri ocular trauma that might explain the subconjunctival hemorrhage, but none was reported. The next day he was lethargic and nauseous. A characteristic vesicular rash erupted on the forehead above his right eye and on the tip of his nose, which lead to the diagnosis of herpes zoster opthalmicus. The patient was hospitalized for intravenous acyclovir. His ophthalmic regimen included ciprofloxacin ointment, 4 times daily, and cyclopentolate, 1%, three times a day. After 4 days, he was discharged home with instruction to take oral acyclovir, 400 mg, 3 times daily, for 1 week. The day after discharge he noted diminished vision in the right eye. Visual acuity was 20/80 and there were 3+ cells in the anterior chamber. The right optic disk showed modest edema. Hourly prednisolone acetate 1% and atropine, twice daily, were administered topically. It was noted that cultures taken during hospitalization were negative. Over the subsequent 2 months, the corticosteroid was tapered. Visual acuity in the right eye returned to 20/20, and both iritis and optic disk swelling resolved. Three months after the initial presentation of herpes zoster opthalmicus, the child experienced pain and photophobia in the right eye. He was found to have keratitis, which consisted of several discrete mid stromal opacities that rapidly resolved with topical corticosteroids. The boy remained asymptomatic at 7 months after initial presentation. It was reported that the only lingering effect was a slight mydriasis of the right pupil which was improving. It was reported that incidences of both wild type varicella and vaccine associated varicella, leading to herpes zoster outbreaks after vaccination, had been reported, which made either source a possible origin of herpes zoster opthalmicus in this case. Additional information has been requested. A copy of the published article is attached as further documentation of the patients experience.