Ocular involvement associated with varicella in adults

Abstract

Background: Varicella is a common infectious disease primarily of childhood that is usually benign and self-limited. It is, however, increasingly seen in adults who are at a higher risk of severe infection. Ocular complications of varicella are relatively uncommon and have been rarely described in adults. We describe herein five adults who developed ocular involvement in association with primary varicella-zoster virus infection.

Findings: Ocular manifestations included acute anterior uveitis in four eyes, with associated stromal keratitis in one of them, epithelial ulcerative keratitis in the two eyes of one patient, and acute retinal necrosis in one eye. One patient with acute anterior uveitis was treated with topical steroids and cycloplegic agents. The four other patients received topical or systemic antiviral drugs, with subsequent resolution of acute ocular inflammatory disease.

Conclusions: The spectrum of chickenpox-associated ocular complications in adults is wide. Early diagnosis and appropriate management are mandatory to improve visual outcome.

Keywords: Acute retinal necrosis; Keratitis; Uveitis; Varicella.

Fig. 1

Slit-lamp photography of case 1. a Slit-lamp photograph showing disciform keratitis. b Slit-lamp photograph showing large pigmented corneal precipitates. c Slit-lamp photograph showing a patchy iris atrophy and a distorted pupil

Fig. 2

Slit-lamp photography of case 4. a Slit-lamp photograph showing a large geographic epithelial defect with stromal edema. b Slit-lamp photograph showing resolution of the corneal defect and corneal edema after treatment with antivirals and oral steroids