Managing ophthalmic herpes zoster in primary care
BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7509.147 (Published 14 July 2005) Cite this as: BMJ 2005;331:147All rapid responses
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Since 1954 Vitamin B.12. has been used in treating Herpes Zoster
wherever in order to restore the Myelin as protection of the virus-damaged
covering to the nerve fibres.
Demyelination occurs with other virus related infections of the
Nervous System, e.g. Multiple Sclerosis, Devic's Syndrome, etc..
Ophthalmic Herpes should instantly, not next day, be treated with
daily injections of B.12. 2,500 mcgs. until all pain goes. Acyclovir
should also prescribed. And arrange same day appointment with an Eye
Specialist to oversee and treat any untoward lesion of the Cornea.
This is the only site in the body where the Virus may cross to the
other side and cause blindness in both eyes.
Herpes Zoster elsewhere can be managed alone with daily injected
Vitamin B.12 up to three weeks of neglect from the onset. It will be too
late after three months of neglect.
Early and instant diagnosis with the first vesicle is esential.
There should be no excuse then for Post Herpetic Neuralgia developing
in the aftermath.
Treat instantly and early with Cyanocobalamin by injection and
healing of the nerve fibres will begin.
Why is this not better known?
Competing interests:
None declared
Competing interests: No competing interests
Stellate blocks have fallen out of fashion, but having had about 10
referrals a year over the last 15 years when patients and their family
doctors or ophthalmologists are at their wits end, the pain releif is very
rewarding for both anaesthetist and patient. A course of three blocks at
48 hour intervals is produces best results if performed within 3 weeks of
onset of severe pain, but even at six or ten weeks the quality of life can
be improved significantly. I personally use a lateral approach, but that
is another story.
Andrew Bacon
Competing interests:
None declared
Competing interests: No competing interests
This article was titled "Managing ophthalmic herpes zoster in primary
care" yet there was no significant mention of treating the pain of this
dreadful condition (see the description in Box 2). Apart from antivirals,
a lubricant and when to refer to an ophthalmologist, there was little else
on "management".
The authors state that the accompanying inflammation of the sensory
nerve and skin damage are supposedly responsible for the acute pain. No,
this IS responsible for the pain , along with changes deeper within the
CNS.
The pharmacological treatment of these patients (who are commonly
elderly) can be very difficult because of the need to use tricyclic
antidepressants, anti-convulsants and strong analgesics. The former are
the one class of drug that have been proven to show useful effect in
controlling pain and preventing the progression into chronicity - a living
hell for some. Any doctor who fails to aggressively manage the pain early
may be condemming the patient to a lifetime of misery. Surely this could
now be considered negligent practice.
This article needed sections on "Management of the pain" and "When
to refer to a Pain Specialist".
Competing interests:
None declared
Competing interests: No competing interests
Pain in herpes ophthalmicus
There will be a quick response by giving daily 2,500 mcgs. Vitamin
B.12 by injection, but one should also administer Anti-Histamines and
Panadol. Pethidine 50-100 mg. PRN by injection may be necesary and should
never be witheld.
One or other of the "Cyclovirs" always should be given in view of the
possible bilateral blindness that may well occur if these treatments are
not begun urgently at the onset. The Vitamin B.12. will prevent that
Chronic Pain.
Depending on the severity, the eyes should be protected from bright
light and kept at rest. Local applications according to what has been
advised by the Eye Consultant in attendance.
Applications of Calamine or Caladryl Lotion to the affected skin
area. Avoid "High Protein Diet". Shell-fish. Offal.
The earliest diagnosis is imperative, with no dilly-dallying. And
get a same-day appointment with the Eye Man.
Competing interests:
None declared
Competing interests: No competing interests