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Painful rash on face

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Treat with antivirals and steroid eye drops

An early diagnosis of HZO is critical to prevent progressive corneal involvement and potential loss of vision. The standard management is to initiate antiviral therapy with oral acyclovir (800 mg 5 times per day or 10 mg/kg intravenously 3 times per day), oral valacyclovir (1 g 3 times per day), or oral famciclovir (500 mg 3 times per day), and to use adjunctive steroid eye drops that are prescribed by an ophthalmologist to reduce the inflammatory response.8

In otherwise healthy individuals in whom HZO causes minimal ocular symptoms, outpatient treatment with 7 to 10 days of antiviral medications is recommended. Immunodeficient patients and those taking immunosuppressive agents should be admitted to the hospital so they can receive intravenous antiviral medications.

Our patient was admitted to the hospital and underwent an ophthalmologic consultation and exam, which showed right erythematous conjunctiva and punctate corneal erosions. The iris, anterior vitreous, macula, and lens all appeared normal. He was given acyclovir 10 mg/kg intravenously and steroid ophthalmic drops, and his pain was controlled with oral oxycodone/acetaminophen (10 mg/325 mg) and ibuprofen 400 mg. Our patient continued to improve and was discharged on oral valacyclovir 1 g 3 times per day and steroid eye drops with outpatient Ophthalmology follow-up.

CORRESPONDENCE
Mahmoud Farhoud, MD, Orlando Veterans Affairs Medical Center, 13800 Veterans Way, Orlando, FL 32827; mahmoud.farhoud@uhhospitals.org.

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