Herpes zoster ophthalmicus

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Background

  • Occurs when varicella zoster virus 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 patients <40yrs

Clinical Features

  • Prodrome of headache, malaise, photophobia, fever
  • Unilateral pain or hypesthesia in V1 distribution
  • Hyperemic conjunctivitis, episcleritis, lid droop

Differential Diagnosis

Conjunctivitis Types

Varicella zoster virus

HIV associated conditions

Evaluation

  • Zoster in distribution of V1
  • Slit-lamp exam:
    • Pseudodendrite (poorly staining mucous plaque with no epithelial erosion
      • In contrast to HSV which has true dendrite with epithelial erosion and staining
    • Cell and flare

Management

  • Cool compresses/lubrication drops
  • Topical antibiotics to skin to prevent secondary infection
  • Antiviral therapy indicated for rash <1wk duration
  • Prevention of reactivation
  • Ophtho consultation regarding steroid use

Disposition

See Also

References

  1. Gutteridge, David L MD, MPH, Egan, Daniel J. MD. The HIV-Infected Adult Patient in The Emergency Department: The Changing Landscape of the Disease. Emergency Medicine Practice: An Evidence-Based Approach to Emergency Medicine. Vol 18, Num 2. Feb 2016.
  2. Wills Eye Manual, 6th edition