Herpes zoster ophthalmicus

Background

• Herpes zoster (HZV) ophthalmicus
• Occurs when the varicella-zoster virus is reactivated in the ophthalmic division of the trigeminal nerve
• 10-25% of all zoster cases
• Most cases involve skin only, but serious ocular involvement can occur (if involves nasociliary branch)
  • Hutchinson’s sign = pustules at tip of the nose
    • Mild specificity for ocular involvement
    • NOT sensitive for ocular involvement

Diagnosis

1. Rash in distribution
2. If corneal invovement
   1. Corneal dedrite on fluorescein stain
      1. Appear branching or ‘‘medusa-like’’ pattern with tapered ends
         1. In contrast to HSV dendrites, which have terminal bulbs

Treatment

1. No corneal involvement
   1. Topical antibiotics may prevent secondary infection
   2. Cool compresses/lubrication drops
   3. Ophtho followup (within 24hrs if any ocular involvement)
2. Corneal involvement
   1. Artificial tears (preservative-free) Q1-2 hrs
   2. Ocular lubricant ointment QHS
   3. Consult ophtho regarding
      1. Systemic or topical antiviral agents
      2. Topical steroids (caution; only in consultation)