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Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 84-85

Herpes zoster ophthalmicus


Department of ENT and Head and Neck Surgery, Mahatma Gandhi Medical College and Research Institute, Puducherry, India

Date of Web Publication12-Jan-2018

Correspondence Address:
Satvinder Singh Bakshi
House Number B2, Shree Pushpa Complex, 15th Bharathi Street, Ananda Nagar, Puducherry - 605 009
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_80_17

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How to cite this article:
Bakshi SS. Herpes zoster ophthalmicus. CHRISMED J Health Res 2018;5:84-5

How to cite this URL:
Bakshi SS. Herpes zoster ophthalmicus. CHRISMED J Health Res [serial online] 2018 [cited 2020 Aug 13];5:84-5. Available from: http://www.cjhr.org/text.asp?2018/5/1/84/223131



A 37-year-old woman presented with fever and headache for 5 days associated with swelling and pain of the eye and face for 3 days. She was diagnosed with diabetes Type II for the past 3 years and was on irregular treatment. On examination, there were multiple vesicles and pustules over the left upper face with erythema and swelling of the face [Figure 1]. Hutchinson's sign which is the involvement of the tip and root of nose by the lesions was positive. The ophthalmic examination revealed congestion of the conjunctiva with small punctate erosions in the cornea and reduced corneal sensitivity, mild uveitis, the intraocular pressure, and fundus examination were however normal. The patient was diagnosed with herpes zoster ophthalmicus which was confirmed by a Tzanck smear [Figure 2]. She was started on acyclovir 800 mg 5 times a day along with acyclovir eye ointment and lubricating eye drops and strict glycemic control. The lesions resolved by day 12 and patient has been asymptomatic 2 months of follow-up. Herpes zoster ophthalmicus is a disease characterized by reactivation of dormant, neurotropic, DNA virus called varicella zoster virus which resides within the ophthalmic division of the trigeminal nerve. The incidence of herpes zoster increases with advancing age and decreased immunocompetence. The risk is highest in patients over the age of 60 and those having HIV. Patients generally have a prodromal period of fever, malaise, headache, and eye pain before the eruption of the skin rash. The skin rash and pain develops along the distribution of ophthalmic division of trigeminal nerve. Hutchinson's sign is due to involvement of the nasociliary nerve and is a strong indicator of ocular involvement and increases the risk of ocular complications. The eye lesions range from small punctate lesions on the cornea to uveitis. The diagnosis is confirmed by Tzanck smear and immunofluorescence to look for IGM antibodies to VZV. Treatment includes acyclovir or valacyclovir given for a period of 7–10 days. The lesions generally resolve by 2 weeks. It is a chronic condition with intermittent flaring, and therefore long-term follow-up of the patients is warranted.
Figure 1: Patient with vesicles, erythema, and swelling in the distribution of ophthalmic division of trigeminal nerve

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Figure 2: Tzanck smear showing multinucleated giant cells with eosinophilic inclusion bodies

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.




    Figures

  [Figure 1], [Figure 2]



 

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