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Coexistent herpes zoster and herpes simplex
986
AMERICAN JOURNAL OF OPHTHALMOLOGY
The business meeting of the research committees tentatively scheduled the next International Congress of Neuro-genetics and Neuro-ophthalmology for 1972 in Brus sels, under the direction of Prof. Jules Fran çois. The proposed theme will be diseases associated with an aminoaciduria. Frank Newell's resignation as secretary for the Western Hemisphere of the Neuro-ophthal mology Committee was accepted and Alex E. Krill was elected secretary. Prof. Franceschetti continues as general secretary of the Committee. A North American symposi um was tentatively scheduled for 1969 to precede the meeting of the American Acade my of Ophthalmology and Otolaryngology. Frank W. Newell
CORRESPONDENCE FIXED PUPIL FOLLOWING KERATOPLASTY
Editor, American Journal of Ophthalmology: May I contribute two suggestions to the most interesting article "Fixed pupil follow ing keratoplasty" by L. E. Uribe (Am. J. Ophth. 63:1682, 1967). One might try to prevent the permanent mydriasis by preoperative and postoperative instillation of 0.25% eserine solution ("Zur Keratoplastikfrage I I I " Graefes Arch. Ophth. 107:451, 1922). To alleviate postoperative photophobia and possibly to improve visual acuity by a pinholelike effect, a scleral-type contact lens with dark-tinted rim might be helpful. Corneal contact lenses would not do the same ("Ringfoermig gefärbte Kontaktglaeser bei albinismus" in Klin. Mbl. Augenh. 85:829, 1930). The contact lenses with scierai flange, which I ordered for an albinotic nov ice in the Hospital of the Fratres Misericordiae in Prague and which were well tol erated, had a dark-colored coat on the inner surface of the flange and periphery of the corneal part while the outer surface of the corneal part showed an iris pattern and the
NOVEMBER, 1967
working pupil was by purpose made quite narrow to increase protection against light and to attempt a pinhole effect. Karl W. Ascher Cincinnati, Ohio
COEXISTENT HERPES ZOSTER AND HERPES SIMPLEX
Editor, American Journal of Ophthalmology : Acers and Vaile, in an article titled "Coexistent herpes zoster and herpes sim plex" (Am. J. Ophth. 63:992, 1967) report such a case and comment on the rareness of the phenomenon. I wish to report a similar case. C A S E HISTORY
H. B., a 69-year-old white woman, was first seen on October S, 1963, with a 10-day history of herpes zoster involving the right side of the scalp, the right forehead, the right upper lid, the right lower lid and the right side of the nose. She had severe iritis with multiple mutton-fat keratic precipitates, heavy cells and flare and punctate staining of the cornea. She was treated with 60 mg of prednisone per day, tapering to 20 mg per day, 5% homatropine four times daily and Hydeltrasol every two hours. Twenty days later she developed a typical dendritic figure on the right cornea. Topical steroids were discontinued and she was treated with IDU every hour in the daytime and every two hours during the night. One week later the dendritic figure disap peared, leaving a superficial nebula. IDU was con tinued twice a day for another three weeks. The eye developed periodic glaucoma which was treated with Diamox. The iritis was completely clear by February 19, 1965. On her last visit on May 7, 1966, there was no residual evidence of iritis, applanation tensions were 16 in both eyes and the corrected visual acuity was 20/30, O.D., and 20/25, O.S. (some nuclear sclerosis).
Such coexistence of herpes zoster and herpes simplex may not be unusual in cases of zoster which are severe enough to require steroid therapy. Perviz B. Mehri Danbury, Connecticut
AMERICAN JOURNAL OF OPHTHALMOLOGY
The business meeting of the research committees tentatively scheduled the next International Congress of Neuro-genetics and Neuro-ophthalmology for 1972 in Brus sels, under the direction of Prof. Jules Fran çois. The proposed theme will be diseases associated with an aminoaciduria. Frank Newell's resignation as secretary for the Western Hemisphere of the Neuro-ophthal mology Committee was accepted and Alex E. Krill was elected secretary. Prof. Franceschetti continues as general secretary of the Committee. A North American symposi um was tentatively scheduled for 1969 to precede the meeting of the American Acade my of Ophthalmology and Otolaryngology. Frank W. Newell
CORRESPONDENCE FIXED PUPIL FOLLOWING KERATOPLASTY
Editor, American Journal of Ophthalmology: May I contribute two suggestions to the most interesting article "Fixed pupil follow ing keratoplasty" by L. E. Uribe (Am. J. Ophth. 63:1682, 1967). One might try to prevent the permanent mydriasis by preoperative and postoperative instillation of 0.25% eserine solution ("Zur Keratoplastikfrage I I I " Graefes Arch. Ophth. 107:451, 1922). To alleviate postoperative photophobia and possibly to improve visual acuity by a pinholelike effect, a scleral-type contact lens with dark-tinted rim might be helpful. Corneal contact lenses would not do the same ("Ringfoermig gefärbte Kontaktglaeser bei albinismus" in Klin. Mbl. Augenh. 85:829, 1930). The contact lenses with scierai flange, which I ordered for an albinotic nov ice in the Hospital of the Fratres Misericordiae in Prague and which were well tol erated, had a dark-colored coat on the inner surface of the flange and periphery of the corneal part while the outer surface of the corneal part showed an iris pattern and the
NOVEMBER, 1967
working pupil was by purpose made quite narrow to increase protection against light and to attempt a pinhole effect. Karl W. Ascher Cincinnati, Ohio
COEXISTENT HERPES ZOSTER AND HERPES SIMPLEX
Editor, American Journal of Ophthalmology : Acers and Vaile, in an article titled "Coexistent herpes zoster and herpes sim plex" (Am. J. Ophth. 63:992, 1967) report such a case and comment on the rareness of the phenomenon. I wish to report a similar case. C A S E HISTORY
H. B., a 69-year-old white woman, was first seen on October S, 1963, with a 10-day history of herpes zoster involving the right side of the scalp, the right forehead, the right upper lid, the right lower lid and the right side of the nose. She had severe iritis with multiple mutton-fat keratic precipitates, heavy cells and flare and punctate staining of the cornea. She was treated with 60 mg of prednisone per day, tapering to 20 mg per day, 5% homatropine four times daily and Hydeltrasol every two hours. Twenty days later she developed a typical dendritic figure on the right cornea. Topical steroids were discontinued and she was treated with IDU every hour in the daytime and every two hours during the night. One week later the dendritic figure disap peared, leaving a superficial nebula. IDU was con tinued twice a day for another three weeks. The eye developed periodic glaucoma which was treated with Diamox. The iritis was completely clear by February 19, 1965. On her last visit on May 7, 1966, there was no residual evidence of iritis, applanation tensions were 16 in both eyes and the corrected visual acuity was 20/30, O.D., and 20/25, O.S. (some nuclear sclerosis).
Such coexistence of herpes zoster and herpes simplex may not be unusual in cases of zoster which are severe enough to require steroid therapy. Perviz B. Mehri Danbury, Connecticut