Chickenpox, Varicella

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Symptoms

  • Red eyes
  • Foreign body sensation

Findings

  • Acute
    • Conjunctivitis with vesicles on conjunctiva, limbus, lid
    • Rare: Keratitis with pseudodendritic lesions, stromal keratitis, anterior uveitis, optic neuritis, retinitis, ophthalmoplegia
  • Late
    • Stromal keratitis (immune reaction), neurotrophic keratitis

Treatment

  • Frequently self-limiting course
  • Conjunctivitis, epithelial corneal lesions
    • Cold compresses
    • If staining with fluorescein: Floxal (ofloxacin) gtt 4x/day
    • +/- Floxal ointment for periorbital lesions
  • Stromal keratitis with anterior uveitis
    • Depending on severity
    • Pred Forte (prednisolone) gtt initially every 2 hours to hourly + Atropine 0.5% gtt twice a day
  • Immunocompromised children: Consider intravenous Acyclovir
  • CAUTION: Aspirin is contraindicated in children due to the risk of Reye Syndrome!
  • Prophylactic vaccination according to the vaccination schedule

Follow-ups

  • Gradually reduce steroids in case of stromal involvement
  • After 4-6 weeks: stromal/neurotrophic keratitis?

Sources

  • Kanski‚Äôs Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)
  • Johnston NR. Red eye in chickenpox: varicella-related acute anterior uveitis in a child. BMJ Case Rep. 2010;2010:bcr0120102678. Published 2010 Sep 17. doi:10.1136/bcr.01.2010.2678