By ULY CLINIC

 

Herpes zoster ophthalmicus

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Introduction

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

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Diagnostic Criteria

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• 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 

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Pharmacological Treatment

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• Acyclovir (PO) 800 mg 4 hourly for 7–10 days 

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AND 

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• Amitriptyline (PO) 25 mg at night for 3 months.

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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 

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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

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Updated on, 2.11.2020

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References

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1. STG