SAQ 425 – Ophthalmology – herpes zoster ophthalmicus

Ophthalmology – herpes zoster ophthalmicus.

a. Diagnosis

• Herpes zoster involving the ophthalmic division of the trigeminal nerve, also acceptable as herpes zoster ophthalmicus.

b. Photograph features

• Unilateral eruption.
• Vesicular clustered rash.
• Distribution confined to the V1 trigeminal dermatome, including forehead and upper eyelid region.
• Surrounding erythema.
• No bilateral rash, target lesions, large bullae, or obvious exudative alternative pattern.

c. Important complications

• Keratitis, uveitis/scleritis, acute glaucoma, optic neuritis, retinitis, or progressive outer retinal necrosis.
• Permanent visual impairment or blindness.
• Post-herpetic neuralgia.
• Secondary bacterial infection.
• Disseminated zoster or sepsis, especially if immunocompromised.
• Meningoencephalitis or cranial nerve palsy, including Ramsay Hunt syndrome.

d. Admission features

• Severe ocular or globe involvement.
• Concern for meningoencephalitis or disseminated infection.
• Immunocompromise.
• Systemically unwell patient.
• Significant secondary bacterial infection.
• Severe pain requiring parenteral opioid analgesia may also justify admission.