An Acute Case of Herpes Zoster Ophthalmicus with Ophthalmoplegia

Hakim, Wasim; Sherman, Rosalie; Rezk, Tamer

doi:10.1155/2012/953910

Cited by 7 publications

(8 citation statements)

References 6 publications

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“…The third oculomotor nerve is most commonly affected, followed by the abducens nerve and the trochlear nerve [ 15 ]. Ophthalmoplegia was also reported [ 14 ],[ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Ocular involvement and visual outcome of herpes zoster ophthalmicus: review of 45 patients from Tunisia, North Africa

Kahloun

Attia

Jelliti

et al. 2014

J Ophthal Inflamm Infect

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BackgroundOcular complications of herpes zoster ophthalmicus (HZO) may lead to substantial visual impairment. The purpose of this study was to characterize and analyze ocular involvement and visual outcome of HZO in patients from Tunisia, North Africa. This study is a retrospective chart review of 51 eyes of 45 patients with HZO.ResultsMean age was 44.5 years. Thirty patients (66.7%) were aged over 50 years. Twenty-four patients (53.3%) were male and 21 patients were female (46.7%). There was no statistically significant difference in gender distribution. Initial mean best corrected visual acuity (BCVA) was 20/50. Ocular manifestations included adnexal involvement (58.8%), keratitis (31.4%), keratouveitis (31.4%), isolated anterior uveitis (AU) (29.4%), intraocular pressure elevation (23.5%), oculomotor nerve palsy (5.8%), and optic neuritis (1.9%). Isolated AU (p < 0.001), isolated keratitis (p = 0.001), and intraocular pressure elevation (p = 0.013) were more likely to be concomitant to HZO active skin disease, while keratouveitis occurred more likely more than 1 month after HZO eruption (p < 0.001). AU and keratouveitis were more likely to be associated with age ≥ 50 years (p = 0.001 and p = 0.02, respectively). Ocular complications included neurotrophic keratopathy (1.9%), corneal opacity (5.9%), secondary glaucoma (7.8%), optic atrophy (1.9%), and postherpetic neuralgia (13.3%). Mean follow-up was 12 months. Mean final BCVA was 20/32; it was ≥ 20/40 in 78.4% of the eyes.ConclusionsOur study provided epidemiologic and clinical data of HZO in a Tunisian population. AU and keratitis were the most common ocular complications. Neurotrophic keratopathy was scarce. The overall visual outcome is good, with about three quarters of the treated patients maintaining VA of 20/40 or better.

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“…The third oculomotor nerve is most commonly affected, followed by the abducens nerve and the trochlear nerve [ 15 ]. Ophthalmoplegia was also reported [ 14 ],[ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Ocular involvement and visual outcome of herpes zoster ophthalmicus: review of 45 patients from Tunisia, North Africa

Kahloun

Attia

Jelliti

et al. 2014

J Ophthal Inflamm Infect

View full text Add to dashboard Cite

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“…These include direct viral cytopathic effect,[ 4 ] reactive immune-related response,[ 4 ] microinfarction secondary to vascular inflammation[ 5 ] or direct compression due to the soft tissue swelling and inflammation at the orbital apex. [ 6 ] Multiple concurrent pathologic mechanisms including ischemia leading to microinfarction might have been responsible for such manifestations with almost no recovery like in our case. Interestingly, almost 90% of the patients with VZV-related ophthalmoplegia disclose evidence of aseptic meningitis, as seen with our patient.…”

Section: Discussionmentioning

confidence: 73%

“…HZO is known to occur more frequently in patients with immunosuppression. [ 8 ] Despite a few anecdotal reports,[ 1 3 6 9 ] it has not been proven conclusively that OAS secondary to HZO occurs more commonly in immune deficient patients. It has been suggested that early treatment with antivirals has a better outcome.…”

Section: Discussionmentioning

confidence: 99%

More than meets the eye: Varicella zoster virus-related orbital apex syndrome

Jun

Gupta

Miléa

et al. 2018

Indian J Ophthalmol

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A 67-year-old male patient with poorly controlled type-2 diabetes mellitus developed an orbital apex syndrome and anterior cavernous syndrome secondary to herpetic zoster ophthalmicus (HZO), despite being on oral acyclovir. Urgent treatment with intravenous acyclovir led to improvement of the orbital and ocular inflammation but had no effect on the complete ophthalmoplegia and profound visual loss. At the 9-month follow-up visit, the patient had complete unilateral ophthalmoplegia and monocular blindness due to optic atrophy.

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“…Acute ophthalmoplegia appearing within the first days of disease presentation is rare. 20 , 21 It was reported that ptosis and ophthalmoplegia caused by HZ appeared to be self-limiting. However, in some patients, residual ptosis and/or limited ocular motility can last indefinitely.…”

Section: Discussionmentioning

confidence: 99%

Successful oral treatment of third cranial nerve palsy and optic neuritis from neglected herpes zoster in an immunocompetent patient

Osman

2020

American Journal of Ophthalmology Case Reports

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Purpose Herpes zoster (HZ) is an acute viral eruption caused by the reactivation of varicella zoster virus (VZV), a herpes virus causing chicken pox in children. We aimed to report a 3-month neglected case of acute herpes zoster-induced third nerve palsy and optic neuritis, followed by a late-onset keratouveitis in an immunocompetent young adult. Observations A 36-year old immunocompetent Egyptian male patient presented with 3-month complaints of blurred vision and drooping of his left upper eyelid that appeared 4 days after a herpetic rash. He had been diagnosed with herpes zoster ophthalmicus (HZO) of the left eye. However, he had not received any systemic antiviral treatment. The patient had an abnormal head posture with post-eruptive scars on the left forehead and the nose tip. Examination revealed weakness of elevation and adduction, partial ptosis, and mid-dilated non-reactive pupil in the left eye. A relative afferent pupillary defect (RAPD) was present in the affected eye. His blood sugar and blood pressure were within normal limits. Contrast magnetic resonance imaging (MRI) showed no space-occupying lesion. However, there were enhancement and enlargement of the left optic nerve on T1-weighted images, denoting optic neuritis. A diagnosis of acute left third nerve palsy with pupil involvement and optic neuritis secondary to HZO was made. Despite late treatment with oral acyclovir and prednisolone, the patient recovered. One and a half months later, he developed a late-onset keratouveitis about 8 months after the rash onset. After the resolution of the episode, oral acyclovir was continued at a prophylactic dose (400 mg BID). Conclusions and importance HZ is a rare cause of third nerve palsy with pupil involvement and optic neuritis. Oral acyclovir and steroids were effective in the delayed treatment in this case. Abnormal optic nerve enhancement on MRI 3 months after the appearance of vesicular rash may suggest chronic HZ activity. Concurrent optic neuritis and third cranial nerve palsy in the absence of other signs of orbital apex syndrome can be seen in cases of HZO. Regular follow-up of patients with HZ is important for detecting recurrence and initiating prompt treatment.

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An Acute Case of Herpes Zoster Ophthalmicus with Ophthalmoplegia

Abstract: Herpes zoster ophthalmicus (HZO) with oculomotor nerve involvement is rare, even rarer as an acute presentation rather than sequelae of HZO. In this paper we present a case of cutaneous HZO in which our patient's initial presentation was one of complete ophthalmoplegia.

Cited by 7 publications

References 6 publications

Ocular involvement and visual outcome of herpes zoster ophthalmicus: review of 45 patients from Tunisia, North Africa

Ocular involvement and visual outcome of herpes zoster ophthalmicus: review of 45 patients from Tunisia, North Africa

More than meets the eye: Varicella zoster virus-related orbital apex syndrome

Successful oral treatment of third cranial nerve palsy and optic neuritis from neglected herpes zoster in an immunocompetent patient

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