1. Information and Methods
1.1 General information
Ocular herpes zoster is a skin disease of a more serious nature, caused by infection of the semilunar ganglion or a branch of the trigeminal nerve with the varicella-zoster virus. The initial manifestations of the disease are clustered blisters, severe neuralgia, eyelid edema, photophobia, and lacrimation in the skin of the distribution area of the affected trigeminal nerve, which can be complicated by keratitis, iridocyclitis, and glaucoma in severe cases [1]. The onset of this disease is rapid, and the patient is in great pain at the onset, often unbearable. In recent years, our department has been using a combination of Chinese and Western medicine to treat wind-heat and poisonous ocular herpes zoster with satisfactory results, which are summarized below.
1.2 Case selection criteria
1.2.1 Western medical diagnostic criteria were formulated with reference to Zhao Jian’s “Clinical Dermatology” [2].
①Prodromal symptoms such as fever, fatigue, general malaise, neuralgia, photophobia, and lacrimation may be present;
(ii) Cluster of blisters on the eyelid skin, not exceeding the midline of the face;
(iii) Radiating neuralgia along the innervation zone is a characteristic feature of the disease;
④Ophthalmologic examination is normal or complicated by keratitis, iridocyclitis, or glaucoma;
(5) Normal, decreased or increased white blood cells;
(6) None of them had been treated with all medications such as antiviral before enrollment.
1.2.2 Diagnostic criteria for the wind-heat and toxin-infused type in Chinese medicine
The rash is flushed, the wall of the blister is tense, burning and stinging; the eyelids are red and swollen, the color of the eyelid is normal, red and red or the white eyes are mixed with red, the mouth is dry and bitter, the urine is dry and the stool is knotted; the tongue is red, the coating is yellow, and the pulse is string.
1.2.3 Exclusion criteria
① Those who do not meet the diagnostic criteria;
②Excluding serious diseases of heart, liver, kidney, hematopoietic system, etc;
③Severe uncontrolled diabetes mellitus and hypertension;
④Pregnant or lactating women;
⑤Patients with mental illness;
(6) Those who do not use the drug as prescribed, cannot judge the efficacy or have incomplete information, etc., which affects the judgment of efficacy or safety.
1.3 Treatment method
Control group:
①In the control group, acyclovir injection 500 mg diluted in 0.9% sodium chloride injection was given intravenously, 2 times/d; vitamin B12 injection, 1 time/d; depigmentation tablets, orally, 1-2 tablets/d, 3 times/d;
(2) Local skin topical application of glyburide lotion, 3 times/d; in case of tense herpes, first extract herpes fluid under the principle of aseptic operation;
③Select sensitive antibiotics for concurrent bacterial infection;
For patients with keratitis, apply acyclovir eye drops once/2h; for patients with iridocyclitis, in addition to acyclovir eye drops for keratitis, apply compound tropicamide eye drops to dilate the pupil 3 times/d; for patients with glaucoma, apply 250 ml of mannitol drops once/d and timolol maleate drops 1-2 times/d, and monitor intraocular pressure daily;
⑤ Hypotension, hypoglycemia and other symptomatic support treatment.
1.4 Observation index
Mainly observe the severity of ocular damage (conjunctiva, cornea, iris-ciliary body, fundus, retina, extraocular muscles), skin damage (the time when no new blisters appeared and the time when blisters began to dry up and crust), the severity of self-conscious symptoms (pain, burning sensation) and the time of reduction or disappearance, and treat for a total of 2 weeks to evaluate the overall efficacy and the average time of cure of the two groups.
1.5 Efficacy criteria
Clinical efficacy assessment criteria [4]: healed: herpes completely subsided, pain disappeared, conjunctival congestion and edema subsided, corneal iridocyclitis disappeared, corneal fluorescein staining was negative, no damage to retinal extraocular muscles; effective: herpes mostly subsided, pain, conjunctival congestion, corneal iridocyclitis significantly reduced; ineffective: herpes did not subside or increased, pain did not reduce, conjunctival congestion, keratitis, iridocyclitis did not Improvement, positive corneal fluorescein staining.
1.6 Statistical methods
SPSS16.0 statistical software was applied for processing, and the measurement data were expressed as ± s. The χ2 test was used for counting data, and the t-test for the mean of two samples was used for comparison between groups.
2, Results
2.1 Comparison of clinical efficacy between the two groups
The clinical efficacy of the two groups was compared after 2 weeks of treatment. 94.3% of the patients in the treatment group were cured, which was significantly higher than that in the control group (80.0%), and the difference between the two groups was statistically different (χ2=4.200, P=0.040<0.05), indicating that the clinical efficacy of the treatment group was significantly better than that of the control group.
3, Discussion
Herpes zoster is a common disease in dermatology, the incidence of which has been increasing year by year in recent years and can occur in any part of the human skin, and improper treatment also leads to the occurrence of posterior neuralgia, which seriously affects patients’ life treatment. Herpes zoster in the eye is one of the most serious and dangerous, which can cause encephalitis, optic nerve damage, and even blindness in the eye. In Chinese medicine, herpes zoster belongs to the category of “snake sore disease”, “entangled waist fire poison”, and “wind red sores”. Herpes zoster of the eye is usually caused by emotional and mental disorders, dietary disorders, external wind-heat and poisonous evil, resulting in loss of spleen health, heat in the spleen meridian, and wind-heat attacking through the meridian.