Date of last review: Due to be updated

Differential diagnosis

  • Herpes simplex keratitis
  • Cellulitis
  • Contact dermatitis
  • Atopic eczema
  • Impetigo

Possible management by Optometrist

Treatment

  • PoM Early treatment with oral Aciclovir (within 72 hours after rash onset) reduces the risk of ocular involvement and lessens acute pain
  • Topical lubricants for relief of ocular symptoms
  • Refer to local Pharmacist for analgesia for pain relief (Paracetamol or Ibuprofen; dose depends on age)

Advice

  • Refer all patients to General Practitioner for a course of oral anti-viral therapy
  • Rest and general supportive measures (reassurance, support at home, good diet, plenty of fluids)
  • Advise avoidance of contact with
    • Elderly or pregnant individuals
    • Babies and children not previously exposed to varicella zoster virus (chicken pox)
    • Immunodeficient/immunosuppressed patients
  • Stronger analgesics (e.g. opiates) may be indicated (co-manage with GP)
  • Review patient at one week to check for development of uveitis

Management Category

  • Emergency referral (same day) to GP for systemic anti-viral treatment
    • Management to resolution if co-managed with GP and keratitis limited to epithelium
  • Urgent referral to ophthalmologist if
    • Uveitis
    • Scleritis
    • Keratitis
    • Retinitis

Possible management by Ophthalmologist

  • Topical steroids