SUMMARY Topical acyclovir has been compared with topical steroids in a coded controlled trial of the treatment of keratouveitis caused by herpes zoster in 40 patients. Topical acyclovir was significantly superior to topical steroids in terms of treatment duration (75 days to 280 days), with no recurrences after the patients were weaned off treatment; there was a 63 % recurrence rate in the steroid group. Corneal epithelial disease resolved significantly quicker in the acyclovir treated group. If recurrences occurred in the steroid group, other parts of the eye not initially affected were also involved. Treatment of such recurrences was more difficult than treatment of the initial attack.It has been estimated that 50% of all cases of herpes zoster involvement of the trigeminal nerve develop ocular lesions and, of these, between 40% and 77% comeal signs and 50% to 60% uveitis.'2 With an approximate incidence of0-2% of herpes zoster in the general population,3 of whom between 7% and 20% will develop ocular lesions, ocular herpes zoster is thus a frequent cause of ocular damage, and so an effective treatment is required.Topical steroids have been used for some time to control the ocular effects of herpes zoster infection, but the treatment has side effects. Treatment is frequently prolonged over many months, and the ocular signs of herpes zoster reappear either during withdrawal of steroids or after they have been stopped. Despite intensive topical steroid treatment severe ocular damage and visual loss may result, and once treatment has been withdrawn vision may gradually be lost owing to the development of corneal scars. Current treatment of ocular herpes zoster infection is unsatisfactory, and an alternative, more effective, treatment is required.Recent advances in the development of antiviral drugs have shown that the new synthetic nucleoside, acycloguanosine (acyclovir, Zovirax) has potential activity against the herpes zoster virus.4 In the immune competent host with herpes zoster infection, acyclovir topically applied appears to control the ocular signs,5 and given systemically it has a beneficial Correspondence to Mr J. McGill, FRCS, Southampton Eye Hospital, Wilton Avenue, Southampton S09 4XW. effect on the rash, reducing cropping and its duration.' No other antiviral has been definitely shown to benefit either the rash or the ocular lesions of herpes zoster.The alternative antiviral therapies tried for herpes zoster ophthalmicus include systemic interferon, which was found to be without effect,'" but this may have been due to the low dose of interferon used in a comparatively short-treatment regimen of 5-10 days and the lack of ocular penetration. Short-treatment regimens have no effect on ocular lesions; systemic acyclovir given for 5 days, while suppressing the cutaneous rash, had no effect on ocular lesions.9 Other antivirals such as systemic adenine arabinoside have also been without effect. "The question arises whether topical acyclovir or steroids are the more effective in the treatment of acute herpe...

In light of their extensive associations, the common pain conditions, persistent pain, restless legs syndrome, iron deficiency, anxiety and depression, are likely to involve common etiological mechanisms that warrant further investigation.

The primary pain disorders of childhood are highly prevalent but have infrequently been studied collectively. Genetic influences have been suggested to be causally implicated. Surveys were sent to 3909 Australian twin families, assessing the lifetime prevalence of growing pains, migraine, headache, recurrent abdominal pain, low back pain, and persistent pain (not otherwise specified) in pediatric twins and their immediate family members. Comparisons between monozygous (MZ) and dizygous (DZ) twin pair correlations, concordances and odds ratios were performed to assess the contribution of additive genetic influences. Random-effects logistic regression modelling was used to evaluate relationships between twin individuals and their co-twins, mothers, fathers and oldest siblings with the subject conditions. Twin analyses of responses from 1016 families revealed significant influence of additive genetic effects on the presence of growing pains, migraine, and recurrent abdominal pain. The analyses for headache, low back pain, and persistent pain overall did not conclusively demonstrate that genetic influences were implicated more than shared environmental factors. Regression analyses demonstrated varying levels of significance in relationships between family members and twin individuals for the tested conditions, with strongest support for genetic influences in growing pains and migraine. These data, together with previously published association analyses, suggest common causal influences including genes.

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PurposeTo further the understanding of growing pains (GP), in particular, the nature of this pain disorder.MethodsThis study included 33 children aged 5–12 years who met criteria for GP (cases) and 29 children without GP of similar age and sex (controls). Nineteen controls were siblings of cases. GP was diagnosed by standard consensus questionnaires. A questionnaire addressed characteristics of the pain and family history of GP. Evidence for peripheral neuropathic disorder was tested by somatosensory testing and provocation tests of peripheral nerves. Somatosensory testing by a blinded researcher involved threshold determination and/or response magnitude to nonpainful stimuli including touch, dynamic brush, cold, vibration, and deep pressure applied to limb and abdominal sites.ResultsDistributional, temporal, and quality characteristics of the pain were in accordance with published descriptions. There was no indication of primary musculoskeletal disorder. No evidence was found that GP is a peripheral neuropathic pain syndrome. There were minor but statistically significantly increased responses to cutaneous cold, vibration, and to deep pressure stimuli in cases compared to controls, evident in a wider distribution than the symptomatic lower limbs.ConclusionGP is a regional pain syndrome with evidence in this study of mild widespread disorder of somatosensory processing.