Herpes Zoster Ophthalmicus

Question 1

What causes herpes zoster opthalmicus?

Answer 1

VZV, chicken pox, shingles

Question 2

What are the risk factors of herpes zoster opthalmicus?

Answer 2

• Age (60-70)

- Compromised immune system (medical or HIV/AIDS)

Question 3

What is the pathogenesis of herpes zoster opthalmicus?

Answer 3

• Caused by VZV (chicken pox, shingles)
• Lies dormant in cranial nerve sensory ganglia (for yrs)
• The virus invades the opthalmic division of trigminal nerva.

Question 4

What are the symptoms of herpes zoster opthalmicus?

Answer 4

• Pain/sensation on forehead on one side
• Fever, Malaise, Headaches, Tiredness
• Rash on forehead and upper lid
• Neuralgia (stabbing/burning due to nerve damage)

Question 5

What are the signs of herpes zoster opthalmicus?

Answer 5

1. Acute epithelial keratitis (after 2 days)
   - punctate epithelial lesions
   - pseudodentrites (4-6 days)
2. Nummular keratitis (after 10 days)
   - fine granular deposits under Bowmann’s layer
   - Halo of stromal haze = stromal keratitis (after 5 weeks)
3. Disciform Keratitis
   - Stromal & epithelial oedema (swelling)
4. Neurotrophic Keratitis
   - Reduced corneal sensation

Question 6

What is the referral and treatment for herpes zoster opthalmicus?

Answer 6

• If acute lesions present = EMERGENCY TO GP -> Oral aciclovir (800mg)
• Ocular involvement = URGENT
• > acute epithelial keratitis will resolve itslef

If deeper corneal layers involved = debridement, lubrication, topical steroid drops