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Show Journal of Clinical Neuro-ophthalmology 8(3): 193, 1988. Editorial Comment This report by Archambault et al. of six patients who developed ophthalmoplegia associated with herpes zoster ophthalmicus reveals that the third nerve was involved in four cases, the fourth nerve in four cases, and the sixth nerve in three cases. Spontaneous, complete recovery occurred in four patients. Aberrant regeneration has not been reported following oculomotor nerve involvement in this syndrome, according to the authors. Since this report has been in press, another excellent review has appeared in the literature (1). It is one of the most outstanding general papers on the subject of varicella-zoster infections that I have seen, and each reader of this journal is encouraged to write for a reprint. The article is from an NIH conference on the subject. The authors recommend treatment of ophthalmic zoster in the normal (i.e., not immunosuppressed) patient with acyclovir, 600 mg, five times a day, orally, for 10 days. (For reprints, write to Wendy Schubert, Sc.M., Clinical Center Communications, Clinical Center, National Institutes of Health, Building 10, Room 1C255, Bethesda, MD 20892, U.S.A.). Don't miss this paper! 193 © 1988 Raven Press, Ltd., New York Finally, a medication that you may want to try in patients with postherpetic neuralgia is Zostrix (capsaicin 0.025% topical analgesic cream), which is made by GenDerm Corporation, 425 Huehl Road, Northbrook, IL 60062, U.S.A. This comes in a 45-g tube and is to be applied to the affected area not more than three or four times daily. I have used this in only a couple of cases and one patient reported that the pain was about "one-third better" with it. However, since there is no excellent treatment at all for postherpetic neuralgia, this is worth a trial. The article cited above recommends amitriptyline for postherpetic neuralgia, too. J. Lawton Smith, M.D. REFERENCE 1. Straus SE, et al. Varicella-zoster virus infections. Biology, natural history, treatment, and prevention. Am Intern Med 1988;108(2):221-37. |
