Herpes zoster ophthalmicus

Herpes zoster ophthalmicus (HZO) describes the reactivation of the varicella zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve. It accounts for around 10% of case of shingles.

Features

• vesicular rash around the eye, which may or may not involve the actual eye itself
• Hutchinson's sign: rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement

Management

• oral antiviral treatment for 7-10 days, ideally started within 72 hours. Topical antiviral treatment is not given in HZO
• oral corticosteroids may reduce the duration of pain but do not reduce the incidence of post-herpetic neuralgia
• ocular involvement requires urgent ophthalmology review

Complications

• ocular: conjunctivitis, keratitis, episcleritis, anterior uveitis
• ptosis
• post-herpetic neuralgia