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ganglion, is caused by re-activation of the varicella-zoster virus (VZV) within the geniculate ganglion and associated sensory nerves. Frequently, other cranial nerves including the VIII, IX, X, and XI nerves are affected suggesting that Ramsay Hunt syndrome may be more properly thought of clinically as a polycranial neuronitis rather than an infection limited to the geniculate ganglion of the seventh cranial nerve [3]. Rapid diagnosis and treatment of this rare neurodermatologic condition is crucial to avoid permanent complications. Signs and SymptomsWhen reactivation of VZV occurs, the patient may experience a prodrome of flu-like symptoms accompanied by a dull, deep, aching sensation in the ear which often progresses to sharper, dysesthetic, neuritic-type pain in the distribution of the geniculate ganglion.

Pain involving the eye has numerous etiologies and is a feared challenge of many clinicians. Between a fear of the patient losing vision and a lack of familiarity with the ophthalmic equipment necessary to diagnose the problem, working up eye pain can be a daunting task. While the ophthalmologist can be indispensable in challenging cases of eye pain, this article will help clarify the unique clinical features of each etiology that can help clinicians narrow down the differential and arrive at a diagnosis.