Contents

Search

Herpes zoster ophthalmicus

Etiology: - Herpes zoster - risk for Herpes zoster ophthalmicus does not seem to correlate with age, gender, or severity of rash [11] Epidemiology: - 3-6% of U.S. in their lifetime [10] - 10-20% of shingles involve ophthalmic division of trigeminal nerve Pathology: - herpes viruses can affect almost every ocular structure, from cornea to retina [9] Clinical manifestations: - manifestations in distribution of the ophthalmic division of trigeminal nerve - unilateral dermatomal involvement characteristic of shingles - paresthesias on affected side [9] - tingling, pain in brow, eyelids, tip of nose - 75% of patients with zoster have prodromal pain (prodromal to skin eruption) [10] - vesicular skin eruption (rash) - up to 2/3 of patients with herpes zoster ophthalmicus have ocular manifestations in addition to the cutaneous lesions - unilateral red eye [9] - eye pain - visual impairment [2] - photophobia [2] - cornea, conjunctiva, iris, retina, optic nerve may be involved [10] - corneal pseudodendrites, a form of keratitis are common - involvement of nasociliary branch of the ophthalmic nerve (30-40%) which innervates tip of nose & cornea [10] - unilateral involvement of the nose (Hutchinson sign) increases the likelihood of ocular involvement * images [4,5,8] Ophthalmoscopy: - corneal pseudodendrites Management: - antiviral treatment for Herpes zoster - acyclovir, valacyclovir or famciclovir - refer to ophthalmology within 24 hours

General

Herpesvirus eye infection Herpes zoster (shingles)

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 15,16.17,18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
  2. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
  3. Adam RS, Vale N, Bona MD, Hasanee K, Farrokhyar F. Triaging herpes zoster ophthalmicus patients in the emergency department: do all patients require referral? Acad Emerg Med. 2010 Nov;17(11):1183-8 PMID: 21175516
  4. Janniger CK, MD; Elston DM (images) Medscape: Herpes Zoster http://emedicine.medscape.com/article/1132465-overview
  5. Wikipedia: Herpes zoster ophthalmicus https://en.wikipedia.org/wiki/Herpes_zoster_ophthalmicus
  6. Pavan-Langston D. Herpes zoster antivirals and pain management. Ophthalmology. 2008 Feb;115(2 Suppl):S13-20. Review. PMID: 18243927
  7. Zaal MJ, Volker-Dieben HJ, D'Amaro J. Prognostic value of Hutchinson's sign in acute herpes zoster ophthalmicus. Graefes Arch Clin Exp Ophthalmol. 2003 Mar;241(3):187-91. PMID: 12644941
  8. Brady MP (images) Cutaneous and Mucosal Manifestations of Viral Diseases. Medscape. March 2017 http://reference.medscape.com/features/slideshow/viral-skin
  9. Hobbs BN Seeing Red: Five Eye Diagnoses Not to Miss Medscape - Apr 23, 2018. https://www.medscape.com/viewarticle/895295
  10. Rothaus C A Man with a Rash on the Scalp and Face. NEJM Resident 360. April 21, 2021 https://resident360.nejm.org/clinical-pearls/a-man-with-a-rash-on-the-scalp-and-face
  11. James W. Fast Five Quiz: Herpes Zoster Facts vs Fiction. Medscape - Sep 22, 2021 https://reference.medscape.com/viewarticle/959182
  12. Frary J, Peterson PT, Pareek M. Hutchinson's sign of ophthalmic zoster. Clin Case Rep. 2019;8(1):219-220 PMID: 31998523 PMCID: PMC6982495 Free PMC article https://onlinelibrary.wiley.com/doi/10.1002/ccr3.2596
  13. Ting DSJ, Ghosh N, Ghosh S. Herpes zoster ophthalmicus. BMJ. 2019;364:k5234 PMID: 30655269 https://www.bmj.com/content/364/bmj.k5234
  14. Vrcek I, Choudhury E, Durairaj V. Herpes zoster ophthalmicus: a review for the internist. Am J Med. 2017;130(1):21-26 PMID: 27644149 https://www.amjmed.com/article/S0002-9343(16)30930-5/fulltext
  15. NEJM Knowledge+ Ophthalmology