Herpes zoster ophthalmicus
Background
- Occurs when VZV is reactivated in the ophthalmic division (V1) of trigeminal nerve
- 50% of cases associated with ocular involvement
- Highly suggested by vesicles at tip of nose (Hutchinson's sign)
- Consider immunocompromise in pts <40yrs
Clinical Features
- Prodrome of HA, malaise fever
- Unilateral pain or hypesthesia in V1 distribution
- Hyperemic conjunctivitis, episcleritis, lid droop
Diagnosis
- Zoster in distribution of V1
- Slit-lamp exam:
- Pseudodendrite (poorly staining mucous plaque w/ no epithelial erosion
- In contrast to HSV which has true dendrite w/ epithelial erosion and staining
- Cell and flare
- Pseudodendrite (poorly staining mucous plaque w/ no epithelial erosion
Differential Diagnosis
Conjunctivitis Types
Treatment
- Cool compresses/lubrication drops
- Topical antibiotics to skin to prevent secondary infection
- Acyclovir indicated for rash <1wk duration
- Treatment - acyclovir IV 10 mg/kg q8hrs x7-10 days[1]
- OR famiciclovir PO 500 mg q8hrs x14 days
- OR valacyclovir PO 1g q8hrs
- Prevention of reactivation
- Acyclovir PO 500 mg 5x per day
- Ophtho consultation regarding steroid use
Source
- UpToDate
- Tintinalli
- ↑ Wills Eye Manual, 6th edition