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Andrew Mincey, Steven A Newman; Unusual Manifestations of Zoster Vasculitis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5790.
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Herpes zoster has had a myriad of potential effects involving the visual pathways including ophthalmoplegia, acute retinal necrosis, and severe post herpetic neuralgia. The propensity of this DNA virus to involve vessels makes other forms of vasculitis possible.
Review of 2 unusual cases of zoster causing vascular occlusive disease affecting the ophthalmic artery and branches of the central retinal artery occlusion were reviewed.
In one of these 2 unusual cases, a central retinal artery occlusion occurred following typical zoster uveitis. The presence of a cilioretinal artery sparred central fixation. The second patient was misdiagnosed with giant cell arteritis. A substantial delay in diagnosis was made because of failure to order fat sat with gadolinium. When the MRI was repeated prominent enhancement was seen of the optic nerve sheath.
Varicella virus has a propensity for involving the vascular system potentially producing occlusive ischemic changes involving both the optic nerve and the retina. Recognition can be difficult if the zoster is not considered.
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