herpes zoster ophthalmicus (HZO)

Question 1

what is herpes zoster ophthalmicus (HZO)?

Answer 1

reactivation of varicella-zoster virus in area supplied by the ophthalmic division of trigeminal nerve accounts for 10% of cases of shingles

Question 2

what are the features of HZO?

Answer 2

1. vesicular rash around the eye (may/may not involve the actual eye itself)
2. Hutchinson’s sign: rash on tip / side of nose = nasociliary involvement; strong risk factor for ocular involvement

Question 3

what is the management for HZO?

Answer 3

1. oral antiviral rx for 7-10 days
   
   • start within 72h
   • IV antivirals for v severe infection/immunocompromised
2. topical corticosteroids to treat 2˚ inflammation of eye
3. ocular involvement → urgent ophthalmology review

Question 4

what are the complications of HZO?

Answer 4

1. ocular: conjunctivitis, keratisis, episcleritis, anterior uveitis
2. ptosis
3. post-herpetic neuralgia

Question 5

Hutchinson’s sign: ‘a rash on the tip, side, or root of the nose, representing the dermatome of the nasociliary nerve’.

what does it suggest?

Answer 5

suggests pending eye inflammation which can cause permanent corneal denervation.

any patients with this sign should be referred for same day specialist assessment.