Please enable JavaScript.
Coggle requires JavaScript to display documents.
Herpes zoster ophthalmicus (Complications (Uveitis, Keratitis …
Herpes zoster
ophthalmicus
Definition
Shingles of the CN V1
dermatome, potentially causing
ophthalmic complications
Epidemiology
15% shingles cases
Pathophysiology
Agent
Herpes zoster virus (VZV), DNA virus
Mechanism
First infection causes chickenpox
VZV latent in CN V1 nerve ganglion
Reactivation affecting dermatome
Nasociliary nerve involvement has higher degree
of ophthalmic complications (tip of nose)
Corneal involvement can cause neutropenic cornea
and more susceptible to secondary infection (keratitis)
Transmission
Direct contact/dropleys
Clinical
presentation
Vesicular rash
CN V1 dermatome
Papules, vesicles, pustules, scabs
Viral prodrome
Preherpetic neuralgia
Tingling/electric pain
Diagnosis
Examination
External eye examination
Vesicular rash of CN V1 dermatome,
Hutchinsons sign (tip of nose involvement)
CN examination
Check acuity, movement etc.
History
DH
Current meds, allergies
SH
Occupation, smoking, alcohol
PMH
Previous chickenpox,
immunocompromised
PC/HPC
Viral prodrome, tingling, rash,
previous chickenpox
Management
Conservative
Refer to ophthalmology
Monitoring (acuity, movements)
Medical
Antiviral
Indication: ASAP as rash appears
E.g. aciclovir PO/IV (immunosuppressed)
Analgesia
Indication: post-herpetic pain
E.g. amitriptyline, gabapentin, topical capsacin
MOA: neuropathic pain
Complications
Uveitis
Keratitis
(bacterial, fungal)
Glaucoma
Post-herpetic pain
(can be severe)
