Herpes zoster opthalmicus

Question 1

Pathophysiology?

Answer 1

Reactivation of the varicella-zoster virus in the area supplied by the opthalmic division of the trigeminal nerve.

Question 2

What rash is present?

Answer 2

• Vesicular rash around the eye, which may or may not involve the eye itself

Question 3

What particular sign is present on the face? What does it mean?

Answer 3

Hutchinson’s sign: rash on the top or side of the nose which indicates nasociliary involvement and is a strong risk factor for ocular involvement

Question 4

Treatment? for how long and when should you start?

Answer 4

Oral antiviral treatment for 7-10 days, ideally started within 72 hours

Question 5

When may you give IV antivirals?

Answer 5

If very severe infection or if the patient is immunocompromised

Question 6

What can be used to treat any secondary inflammation of the eye?

Answer 6

Topical corticosteroids

Question 7

What needs to happen to the patient if it involves the eye?

Answer 7

Urgent opthalmology review

Question 8

Complications?

Answer 8

Conjunctivitis, keratitis, episcleritits, anterior uveitis, ptosis, post-herpetic neuralgia