Herpes Zoster Opthalmicus

Question 1

What is HZO?

Answer 1

The reactivation of VZV in the opthalmic division of the trigeminal nerve.

Question 2

What percentage of shingles cases dose it occur in?

Answer 2

10%

Question 3

What is Hutchinson’s sign?

Answer 3

Rash on the tip or side of the nose.

It indicates nasocilliary involvement and is a strong risk factor for ocular invovlement.

Question 4

What is the feature of HZO and does it need to involve the eye?

Answer 4

A rash around the eye but it may not even involve the eye itself.

Question 5

What are some complications of HZO?

Answer 5

1. Ocular: conjunctivitis, keratitis, episcleritis, anterior uveitis
2. Ptosis
3. Post-herpetic neuralgia

Question 6

How is it acutely managed?

Answer 6

1. Oral aciclovir for 7-10 days - starting within 72 hours of rash appearing.
2. Pain relief - paracetamol +/- Codeine
3. Oral steroids can be considered - but not to be given if chronic diseases like diabetes, renal insufficiency and hypertension.

NOT TOPICAL aciclovir!!!!

Question 7

When should someone be referred and in what manner?

Answer 7

Consider urgent referral if HZO:

but especially if Hutchinson’s sign, visual symptoms or unexplained red eye.