Varicella episcleritis

Varicella (chickenpox) is caused by the varicella-zoster virus (VZV) and typically presents with fever and a vesicular rash. However, in some cases, it can also cause ocular complications, including episcleritis.

Varicella-Associated Episcleritis

Episcleritis is an inflammation of the episclera, the thin vascular layer between the conjunctiva and the sclera. When caused by varicella, it may present with:

• Redness in one or both eyes (sectoral or diffuse)

• Mild eye discomfort (but usually not severe pain)

• No significant vision loss (unlike scleritis, which can be more severe)

• Possible associated vesicular rash around the eye or face

Pathophysiology

• Direct viral invasion: VZV can infect the episcleral blood vessels, leading to inflammation.

• Immune response: An inflammatory reaction triggered by the virus may contribute to the symptoms.

• Herpes zoster ophthalmicus (HZO) connection: If the patient has a history of shingles, especially affecting the ophthalmic branch of the trigeminal nerve, they may be at risk for ocular complications.

Management

• Supportive care: Artificial tears, cold compresses, and NSAIDs for mild cases.

• Antivirals (if active infection is present): Acyclovir, valacyclovir, or famciclovir to reduce viral replication.

• Topical steroids (if severe inflammation occurs): Used cautiously under ophthalmologic supervision to reduce inflammation.

• Ophthalmology referral: If symptoms persist or worsen, an evaluation is necessary to rule out deeper involvement, such as keratitis, uveitis, or scleritis.

Would you like more details on related complications, such as herpes zoster ophthalmicus?