Herpes Zoster Ophthalmicus

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Occurs when Varicella zoster reactivates in the trigeminal ganglion and passes down the ophthalmic division of the trigeminal nerve

Cause

• Varicella zoster virus

Signs and symptoms

• Painful vesicular rash in the trigeminal nerve dermatomes
• Some patients develop conjunctivitis, keratitis, uveitis, retinitis and cranial nerve involvement (oculomotor and optic nerve)
• Later: chronic ocular inflammation, loss of vision, post-herpetic neuralgia

Investigations

• HIV Testing

Pharmacological treatment

Acyclovir oral 800mg every 4 hours for 7-10 days PLUS Amitriptyline oral 25mg at night for 3 months If contraindicated select an appropriate alternative Note: -          Antiviral treatment with acyclovir should be initiated within 3 days from the onset of symptoms -          HIV infected patients should be treated with anti-HIV medicines in addition to acyclovir

Refer to ophthalmologist for specialist care