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Abstract: The patient in this case is a 65-year-old man who presented with scattered erythema with blisters and pain on the right forehead and upper eyelid. The final diagnosis of ocular herpes zoster was confirmed by physical examination and in combination with other relevant tests. After communicating with the patient about the situation, medication was administered, and the patient was treated with a combination of timely antiviral, nerve nutrition, analgesia, and Chinese medicine. The patient’s rash subsided, pain subsided, and vision normalized. The most serious consequence of herpes zoster may lead to blindness, so timely treatment is necessary!
Basic information】Female, 65 years old
Disease Type】Herpes zoster of the eye
Hospital】Tianjin Haihe Hospital
Time】August 2019
Treatment plan】Medication (vaxilovir hydrochloride tablets, acyclovir cream, acyclovir eye drops, methylprednisolone tablets, mecobalamin tablets, vitamin B12 tablets, gabapentin capsules) + external Chinese medicine treatment (acupuncture, local pricking and bloodletting)
Treatment period】17 days of outpatient treatment
Treatment effect】Rash subsided, pain relieved, vision normalized
I. Initial consultation
The patient reported that he had a right-sided headache 3 days ago, with radiating pinprick-like pain to the right orbit, accompanied by a burning sensation, especially at night. 1 day ago, scattered erythema appeared on the right forehead and upper eyelid, with blisters on some of the erythema, and the pain worsened. The patient had no previous underlying diseases such as hypertension and diabetes, and was upset by family matters one week before the onset of the disease. The patient was found to have a cluster of red macules and papules on the right forehead and upper eyelid, and the bulbar conjunctiva was congested; blood pressure, blood glucose, and electrocardiogram were normal; visual acuity of the right eye was 5.0. The relevant blood tests were completed and showed that leukocytes were elevated, neutrophils were decreased, lymphocytes were elevated, and CRP was normal.
II. Treatment history
At the time of the patient’s visit, the bulbar conjunctiva was involved, but the cornea was not yet involved and the vision was not yet affected by the ophthalmology consultation. The first priority of treatment was antiviral therapy to control the progression of the disease, protect the eye tissue and prevent vision loss. The first step was to give antiviral treatment with a full course and dose of oral vaxilovir hydrochloride tablets, topical acyclovir cream for the skin rash, avoiding water, and topical acyclovir eye drops for the eye conjunctiva. Considering the patient’s age, the short duration of the disease, the intense inflammatory reaction, and the fact that the patient had no obvious underlying disease in the past, the blood pressure, blood glucose and electrocardiogram were checked in the normal range upon admission, and the patient was given methylprednisolone tablets for anti-inflammation and methylcobalamin tablets and vitamin B12 tablets for nerve nutrition. If the patient’s pain is obvious and affects sleep, gabapentin capsules are given to relieve the pain. Since TCM has rich experience and efficacy in the treatment of herpes zoster, it was combined with tongue and pulse and medical history to identify and treat the symptoms, together with acupuncture and local pricking and bloodletting.
III. Treatment effect
On the 3rd day of treatment, the patient’s rash was significantly reduced, no new rash appeared, the original rash apparently started to dry up and darken, started to crust, pain was reduced compared with before, retesting visual acuity 5.0, no further involvement of eye tissue. On the 8th day of treatment, the glucocorticoid was stopped; on the 11th day of treatment, the pain was significantly reduced and the rash had basically crusted off, leaving only a small amount of scabs and post-inflammatory discoloration. At this time, the patient’s bulbar conjunctival congestion had subsided, the visual acuity was retested at 5.0, and the blood picture was not significantly abnormal, so the gabapentin capsules and antiviral drugs were stopped. The patient was cured after 17 days of treatment with local acupuncture and bloodletting.
IV. Notes
We are glad that the patient was cured of the disease after treatment. Herpes zoster is caused by varicella-zoster virus, which is contagious and may lead to chickenpox if it infects people who have not had chickenpox. Therefore, before the blisters dry up and crust over, try to avoid close contact with others and wash your clothing separately, especially for patients with infants and children at home. After the rash appears in patients with shingles, try to avoid local exposure to water to prevent secondary bacterial infection. Keep the rash dry and clean, and when there is exudation or pus, use saline or epsom saline lactate solution to clean the wound before applying the medicine. It is recommended to eat a light diet, avoid spicy stimulation, ensure sleep and a relaxed mood, and recommend daily consumption of chrysanthemum tea, green tea, dandelion tea, etc. to cool off the fire. The course of herpes zoster is usually 2-3 weeks. Early treatment is the key to prevent and treat postherpetic neuralgia, and it is necessary to remember to seek medical attention in a timely manner and not to delay the disease by believing in prescriptions.
V. Personal insights
1, the causes of shingles in middle-aged and old people are mostly related to emotions, and Chinese medicine believes that emotions are related to the liver, and that emotional and moral discomfort can lead to poor qi and blood flow, which in turn causes and aggravates pain.
2. Herpes zoster of the head and face, in particular, should be beware of the corresponding dangerous consequences of trigeminal nerve involvement, which can lead to corneal perforation and blindness on the involved side of the eye. . Therefore, patients and family members should pay attention and seek timely medical attention, and clinicians should provide timely and effective diagnosis and treatment according to the condition in order to prevent related complications.