Trigeminal extracranial thermocoagulation along with patientcontrolled analgesia with esketamine for refractory postherpetic neuralgia after herpes zoster ophthalmicus:A case report

BACKGROUND Primary trigeminal neuralgia can achieve satisfactory results through clinical treatment and intervention.The pathogenesis of neuralgia caused by varicellazoster virus infection of the trigeminal nerve is more complex,and it is still difficult to relieve the pain in some patients simply by drug treatment or surgical intervention.CASE SUMMARY A 66-year-old woman was hospitalized with herpetic neuralgia after herpes zoster ophthalmicus(varicella-zoster virus infects the ophthalmic branch of the trigeminal nerve).On admission,the patient showed spontaneous,electric shocklike and acupuncture-like severe pain in the left frontal parietal region,and pain could be induced by touching the herpes area.The numerical rating scale(NRS)was 9.There was no significant pain relief after pulsed radiofrequency and thermocoagulation of the ophthalmic branch of the trigeminal nerve.Combined with patient-controlled intravenous analgesia(PCIA)with esketamine,neuralgia was significantly improved.The patient had no spontaneous pain or allodynia at discharge,and the NRS score decreased to 2 points.The results of follow-up 2 mo after discharge showed that the NRS score was≤3,and the Pittsburgh Sleep Quality Index score was 5 points.There were no adverse reactions.CONCLUSION Trigeminal extracranial thermocoagulation combined with esketamine PCIA may be a feasible method for the treatment of refractory herpetic neuralgia after herpes zoster ophthalmicus.

Ocular manifestation and visual outcomes in herpes zoster ophthalmicus:a prospective study from a tertiary hospital of Eastern India

AIM:To estimate the magnitude of different ocular manifestation in clinically established herpes zoster ophthalmicus(HZO)patients and assessment of the visual outcome after two months of initial examination.METHODS:An observational prospective study was conducted on 42 clinically diagnosed Tzanck smear positive cases HZO to observe the occurrence and frequency of different ocular manifestation and their visual outcome in 10-month period with 2mo follow up.Full ophthalmological examination using slit lamp,non-contact tonometry,applanation tonometry,direct and indirect ophthalmoscope were performed.RESULTS:Out of 42 patients of HZO,33 had one or more type of ocular manifestation staring from lid skin involvement to conjunctivitis,keratitis,uveitis,increased intraocular pressure(IOP)and optic neuritis but no retinal manifestation.More number of HZO cases and ocular manifestation were found with advancement of ages.Young HZO patients were more associated with human immunodeficiency virus(HIV)infection and HIV infected people with HZO infection had more ocular manifestation.Male to female ratio was 2:1 among HZO cases but ocular manifestation occurred more among males.Female with advanced age were involved more.Lid involvement(73.81%),conjunctivitis(69.05%),and keratitis(59.52%)were most common ocular manifestation followed by anterior uveitis(30.95%)and episcleritis(11.90%).Ocular hypertension(42.86%)was associated with almost every ocular manifestation.Among the cases of more than 45 years of age,9.52%patients acquired 6/6 vision compared to 7.14%patients at and below 45 years of age after 8wk of follow up.CONCLUSION:The visual outcomes are poor in HZO with advanced age group.Visual outcome of the affected eyes is poor than unaffected eyes.The loss of vision is mainly due to keratitis,anterior uveitis,posterior uveitis,and optic neuritis.