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Images in Neurology |

Laser Scanning In Vivo Confocal Microscopy Demonstrating Significant Alteration of Human Corneal Nerves Following Herpes Zoster Ophthalmicus

Dipika V. Patel, PhD, MRCOphth; Charles N. J. McGhee, PhD,  FRCOphth
Arch Neurol. 2010;67(5):640-641. doi:10.1001/archneurol.2010.62.
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A 60-year-old woman with herpes zoster ophthalmicus (HZO) of the right eye was treated with 800 mg of acyclovir 5 times per day for 7 days. There was no significant medical history. She developed reduced vision and ocular pain due to HZO disciform keratouveitis (a central disclike region of corneal edema with focal endothelial deposits of lymphocytes and associated mild uveitis) in the right eye, which was treated with topical prednisolone acetate, 1%, 4 times daily. The topical regimen was tapered over 6 weeks, and several attempts were made to stop treatment with all topical corticosteroids in the subsequent months; however, this resulted in reoccurrence of the disciform keratouveitis.

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Figure 1.

Montage of 172 in vivo confocal microscopy images depicting the normal architecture of the subbasal nerve plexus in the subject's left cornea.

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Figure 2.

In vivo confocal microscopy images of the right cornea. A, Occasional nonbranching subbasal nerves (arrow) were visible in midperipheral cornea. B, A bare Bowman layer is shown. C, Langerhans antigen presenting cells (arrowheads), with hyperreflective cell bodies and cell processes are shown.

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