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Chapter 10 : Viral Disease of the Eye

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Viral Disease of the Eye, Page 1 of 2

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Abstract:

The eye and its adnexal structures are subject to a number of viral diseases. The initial part of this chapter discusses anatomic and physiological considerations of the eye and its principal clinical syndromes. Ocular disorders are classified according to the affected anatomic structures, for the most part, for example, keratitis, uveitis, cataract, and retinitis. The latter part of this chapter discusses the eye's major viral diseases and highlights selected risk groups. The development of and advances in antiviral therapies have made many of the viral diseases of the eye amenable to treatment. Acute retinal necrosis (ARN) is most commonly caused by varicella-zoster virus (VZV) infection but it may also be caused by herpes simplex virus (HSV), cytomegalovirus (CMV), or Epstein-Barr virus (EBV) infection. The development of ARN may be related to an impairment of cell-mediated immunity. Ocular adenoviral infection results in an acute, self-limited disease that varies considerably in severity and typically affects children and young adults. As most infections with adenovirus are self-limited and resolve without sequelae, the only indications for corticosteroid use are cicatrizing conjunctival disease or visual compromise resulting from corneal cellular infiltrates or scarring.

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10

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Ocular Infections
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Immune Systems
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Figures

Image of FIGURE 1
FIGURE 1

Diagram depicting a cross-section of the eyelids and globe. (Courtesy of Lloyd-Luke Ltd.)

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
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Image of FIGURE 2
FIGURE 2

Sectorial atrophy of the iris and localized cataract secondary to HSV uveitis.

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
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Image of FIGURE 3
FIGURE 3

ARN syndrome demonstrating peripheral necrotic retinal lesions, the view of which is impeded to some extent by vitreous inflammation. (Courtesy of S. Lightman.)

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
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Image of FIGURE 4
FIGURE 4

Subepithelial punctate infiltrates of established adenoviral keratitis.

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
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Image of FIGURE 5
FIGURE 5

Primary HSV infection affecting the face and eyes bilaterally in an atopic individual.

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
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Image of FIGURE 6
FIGURE 6

Herpes zoster affecting the first ophthalmic division of the trigeminal nerve. Note the periocular edema, vesicles, and crusts.

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
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Image of FIGURE 7
FIGURE 7

(Top) Persisting epithelial ulceration secondary to unsatisfactory herpes zoster pretreatment. (Bottom) Resolution of the ulceration with inactive corneal scarring following treatment with ocular lubricants and steroids 2 years later.

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
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Image of FIGURE 8
FIGURE 8

Inactive corneal scarring secondary to VZV infection.

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
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Image of FIGURE 9
FIGURE 9

Lipid keratopathy resulting from scarring and vascularization of the cornea as a result of VZV.

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
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Image of FIGURE 10
FIGURE 10

CMV retinitis with a large superior sector of necrosis and perivenous sheathing. (Courtesy of R. Markham.)

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
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Image of FIGURE 11
FIGURE 11

Molluscum lesion of the upper eyelid margin. Note the lack of umbilication.

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
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Image of FIGURE 12
FIGURE 12

Herpes zoster ophthalmicus occurring in a young African patient with HIV infection. (Courtesy of I. Mohammed.)

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
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Image of FIGURE 13
FIGURE 13

HIV microangiopathy showing retinal nerve fiber infarcts.

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
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Image of FIGURE 14
FIGURE 14

Buphthalmos associated with congenital glaucoma with obvious enlargement of both the right and left corneas.

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
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Tables

Generic image for table
TABLE 1

Viral causes of conjunctivitis

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
Generic image for table
TABLE 2

Viral causes of keratitis

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
Generic image for table
TABLE 3

Viral causes of scleritis and episcleritis

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
Generic image for table
TABLE 4

Viral causes of uveitis

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
Generic image for table
TABLE 5

Viral causes of retinal disease

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
Generic image for table
TABLE 6

Viral causes of ocular adnexal disease

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
Generic image for table
TABLE 7

Stromal manifestations of HSV

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
Generic image for table
TABLE 8

Viral causes of neurologic ocular disease

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
Generic image for table
TABLE 9

Anterior-segment manifestations of HIV infection

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
Generic image for table
TABLE 10

Posterior-segment manifestations of HIV infection

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
Generic image for table
TABLE 11

Neuro-ophthalmic manifestations associated with HIV infection

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10
Generic image for table
TABLE 12

Viruses associated with congenital ocular disease

Citation: Shuttleworth G, Easty D. 2009. Viral Disease of the Eye, p 143-166. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815981.ch10

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