Varicella zoster virus (VZV) reactivation in ophthalmic division of the trigeminal nerve and subsequently the eye.
- OPHTHALMOLOGIC EMERGENCY (as sequelae often include severe chronic pain and vision loss)
Clinical features
- Burning/shooting pain followed by an erythematous vesicular/pustular rash to the same area
Constitutional symptoms:
Fever, fatigue, malaise, and headaches
Ocular manifestations:
- Conjunctivitis
- Uveitis
- Episcleritis
- Keratitis
- Retinitis
Hutchinson sign:
Indicates nasociliary branch involvement of V1
Management
Supportive care:
Artificial tears, cold compresses, and analgesics
Antiviral agents:
Treatment with systemic antiviral agents should begin within 72 hours of disease onset
- Acyclovir
- Valacyclovir
- Famciclovir
Topical antibiotics
Help prevent secondary bacterial infection.
- Erythromycin ophthalmic ointment)
Corticosteroids:
- Systemic corticosteroids: Herpes zoster treatment, including HZO.
- Topical corticosteroids: Stromal keratitis, uveitis, and trabeculitis.
Topical aqueous suppressants:
Used in combination with topical corticosteroids in the treatment of elevated IOP secondary to HZO
Debridement:
In cases of epithelial keratitis.