a
aHerpes zoster ophthalmicus

This is caused by reactivation of herpes zoster virus in patient who previously had chickenpox. The eye is affected in 50% of zoster ophthalmicus and is increased in patients with involvement of the nasociliary nerve (rash at the tip of the nose). 

Presentation:

  • pain in the distribution of the ophthalmic nerve followed in a few days with vesicular eruption 
Examination
  • Vesicular rash affecting the scalps and lids
  • Vision may be reduced with ocular involvement (keratitis and anterior uveitis)
  • Swollen lids may make eye examination difficult
  • Ocular injections
  • Discharge from conjunctivitis


Management:

  • Oral acyclovir is useful in speeding up the resolution of the rash
  • Analgesia should be given as the condition is very painful
  • Conjunctivitis is common and does not require treatment
  • Referred to the ophthalmologists within  24 hours from seeing for exclusion of ocular involvement such as iritis and keratitis.

 
Figure 1.
This 78 year-old woman presented to the GP with a 3 day-history of right sided headache. 
The GP suspected giant cell arteritis but her ESR was normal. Within 24 hours, she 
developed this vesicular rash typical of herpes zoster ophthlamicus. Note the distribution
of the rash which corresponds to the dermatome of the ophthalmic nerve. She was referred 
to the eye casualty and was found to have anterior uveitis. She was treated with topical 
steroid and mydriatic drops.

Return to swollen lids