This is caused by reactivation of
herpes zoster virus in patient who previously had chickenpox. The eye is
affected in 50% of zoster ophthalmicus and is increased in patients with
involvement of the nasociliary nerve (rash at the tip of the nose).
Presentation:
-
pain in the distribution of the ophthalmic
nerve followed in a few days with vesicular eruption
Examination
-
Vesicular rash affecting the scalps
and lids
-
Vision may be reduced with ocular involvement
(keratitis and anterior uveitis)
-
Swollen lids may make eye examination
difficult
-
Ocular injections
-
Discharge from conjunctivitis
Management:
-
Oral acyclovir is useful in speeding
up the resolution of the rash
-
Analgesia should be given as the condition
is very painful
-
Conjunctivitis is common and does not
require treatment
-
Referred to the ophthalmologists within
24 hours from seeing for exclusion of ocular involvement such as iritis
and keratitis.
|
Figure 1.
This 78 year-old woman presented
to the GP with a 3 day-history of right sided headache.
The GP suspected giant cell arteritis
but her ESR was normal. Within 24 hours, she
developed this vesicular rash typical
of herpes zoster ophthlamicus. Note the distribution
of the rash which corresponds to
the dermatome of the ophthalmic nerve. She was referred
to the eye casualty and was found
to have anterior uveitis. She was treated with topical
steroid and mydriatic drops. |
Return
to swollen lids |