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Abstract: An elderly patient presented to the hospital with “erythema and blistering with pain on the right side of the head and face, involving the conjunctiva of the right eye, affecting vision and making it difficult to sleep due to the pain”. The patient’s mood fluctuated due to pain, so while psychologically reassuring the patient, he was given relevant examinations and a clear diagnosis of ocular herpes zoster and conjunctivitis was made. Oral + topical medication was given, supplemented by local red light irradiation. After treatment, the patient’s condition was controlled and the erythema and blisters subsided and crusted over.
Basic information】Female, 65 years old
Disease Type】Herpes zoster, conjunctivitis
Hospital】Shenyang Hospital of Integrative Medicine
Date of Consultation】May 2022
Treatment plan】Medication (vaxilovir hydrochloride tablets, mecobalamin tablets, acyclovir eye drops, ganciclovir ophthalmic gel)
Treatment period】14 days of outpatient treatment, 1 week of outpatient follow-up
Treatment effect】The disease has been controlled and the erythema and blisters have disappeared.
I. Initial consultation
The patient was found to have erythematous patches on the right side of the head and face with no obvious cause one month ago, and densely distributed small blisters appeared on top of the erythematous patches. The patient took ibuprofen capsules, which slightly relieved the pain, but the rash continued to expand and involved the right eye at the same time. The right conjunctiva was congested, the right eyelid was swollen, and the vision was unclear. The patient was afraid of losing her right eye, so she came to our hospital for treatment. The patient was very anxious and had a painful expression due to the pain and the concern about her eyes. Based on the patient’s symptoms (pain), as well as the distribution of the rash (unilateral banded distribution of blisters), the involvement of the eye (right conjunctival congestion), and the routine blood tests given, the diagnosis of herpes zoster and right conjunctivitis was made based on the above symptoms and blood tests suggesting viral infection. We promptly calmed the patient’s emotions and informed him that the current conditions were all brought on by herpes zoster and could be completely cured with treatment. The patient gradually regained his emotional stability and expressed his willingness to cooperate with treatment.
(Interview)
II. Treatment process
Step 1: Diagnosis was clarified and the patient’s current condition was evaluated by routine blood tests. The patient’s routine blood test returned elevated monocytes, suggesting a viral infection.
Step 2: Pharmacological treatment was given with vaxilovir hydrochloride tablets and mecobalamin tablets orally, acyclovir eye drops and ganciclovir ophthalmic gel for conjunctivitis for 14 days (specific dosage and frequency should be consulted with the treating physician or hospital visit).
Step 3: Ask the ophthalmology consultation to assist in the diagnosis and treatment to prevent misdiagnosis and omission. After the ophthalmology consultation, agree to the current diagnosis and medication, and suggest regular review after medication.
Step 4: Come to the hospital every day to give red light local irradiation to promote the blisters to subside and inflammation absorption. The patient was told that the disease could not disappear suddenly, but would only gradually remit until it was cured, and that he must adhere to all the treatments and review them regularly. Patients said they will strictly follow the medical advice to treat.
III. Treatment effect
After 14 days of treatment, the patient was basically pain-free and slept well. After the improvement of sleep, the patient’s mood was much better, and most of the erythema on the right head and face and right eyelid had subsided, and the remaining color had become significantly lighter, its blister had subsided and partially crusted, and the remaining part of the scab had not completely fallen off. The blood test was repeated, and all the return indexes turned to normal level. The herpes zoster in the right eye was basically cured, and the conjunctivitis in the right eye was also significantly improved. The patient was advised to continue using eye drops and ointment for 1 week and then revisit the clinic. Compared with the initial consultation, the patient showed significant improvement from rash to mental status, and the obvious effect of the treatment made the patient trust us more and follow the medical advice more.
IV. Notes
We are glad that the patient’s condition has improved significantly after treatment, but there are still some things that need to be noted.
1, a large part of the causes of shingles is the patient’s fatigue, low immunity, coupled with poor rest, such as staying up late, so rest is critical.
2, do not get wet before the local rash is completely healed, to prevent secondary infection.
3, the medication should reach the course of treatment, the patient’s condition is heavy, antiviral treatment for at least 10 days, together with nutritional nerve therapy, if the patient still has pain, nutritional nerve therapy can extend the treatment time.
4. The disease is slightly contagious at the beginning, so if the patient is surrounded by frail elderly people or young children, it is recommended to avoid contact to avoid infecting family members and causing chickenpox or herpes zoster.
V. Personal insight
Herpes zoster is a common dermatological disease characterized by erythema and blisters accompanied by pain, especially pain that often causes great physical and psychological torture, severe pain can affect the patient’s sleep, which in turn causes mood swings and further aggravation of the disease. Herpes can also cause many complications when it affects the head and face, such as ocular herpes zoster, ear herpes zoster, facial palsy, and viral meningitis. Therefore, herpes zoster of the head and face must be taken very seriously and treated according to the treatment protocols, while treating herpes zoster together with the complications to reduce post-herpetic neuralgia and damage to vital organs. In addition to the necessary clinical treatment, psychological counseling is also crucial. In this case, the patient’s pain and eye damage caused great emotional fluctuations, which is not good for the treatment and recovery of the patient. At the same time, informing patients of daily precautions and strengthening daily care will also speed up the recovery of the disease.