Herpes Zoster Ophthalmicus

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Occurs  when  Varicella  Zoster  Virus  reactivates  in  the  trigeminal  ganglion  and  passes  down  the  ophthalmic division of the trigeminal nerve.

Clinical presentation 

  • Presents with painful vesicular rash in the trigeminal V1 area –vesicles on the tip of the nose indicate nasociliary branch involvement and increases the risk of ocular involvement
  • Some patients develop conjunctivitis, keratitis, uveitis, retinitis and cranial nerve involvement (oculomotor and optic nerves)
  • Later, chronic ocular inflammation, loss of vision, post herpetic neuralgia

All patients should be offered HIV testing.

Investigations 

  • Visual acuity
  • Slit lamp bimicroscopy
  • Corneal sensation test
  • Fluorescein staining
  • HIV Testing

Pharmacological Treatment 

B: acyclovir (PO) 800mg 4hourly for 7–10days 

AND  

A: amitriptyline (PO) 25mg at night for 3months. 

Note: 

  • Treatment should be initiated within 3 days of the onset of symptoms, except in HIV infected patients who should be treated if there are active skin lesions
  • Management of Herpes Zoster is multidisciplinary so consult physician for proper management of the patient

Referral

Refer to eye specialist in case of:

  • Vesicles on the tip of the nose
  • Fluorescein staining of the cornea shows corneal ulceration
  • Decreased vision
  • Red eye (uveitis or keratitis)
  • Cranial nerve palsies