Herpes Zoster Ophthalmicus with Orbital Apex Syndrome—Difference in Outcomes and Literature Review

Varicell Zoster Virus-Associated Uveitis

“…The patient's findings resolved promptly following initiation of intravenous acyclovir and oral prednisone. The authors noted that posterior scleritis is uncommon in patients with HZO, but cited a similar presentation, including choroidal detachment, reported by Tranos et al 30 Lim et al 12 described two patients with HZO who developed orbital apex syndrome (OAS), a spectrum disorder characterized by relative or complete dysfunction of the second, third, fourth, sixth and ophthalmic division of the fifth cranial nerves due to injury, hemorrhage, thrombosis, mass, or inflammation at or near the apex of the orbit. They also reviewed nine additional cases reported in the literature.…”

“…A complete neurologic evaluation, and in some patients neuroimaging, should be performed to rule out central nervous system involvement. One review, 7 three original articles, [8][9][10] and three case reports [11][12][13] in this issue of Ocular Immunology & Inflammation (OII) address important aspects of the pathogenesis, diagnosis, complications, and management of VZVassociated uveitis.…”

Orbital apex syndrome as an unusual complication of herpes zoster ophthalmicus in HIV-positive young man: a case report

“…HZO refer to neurocutaneous disease caused by herpes zoster infection with ophthalmic division of trigeminal nerve involvement. It accounts for 10 to 20% of herpes zos-glion, involving ophthalmic division of trigeminal nerve [3,4]. Between 20 to 70% of patients with HZO presented with ocular involvement include blepharitis, keratoconjunctivitis, iritis, scleritis, and acute retinal necrosis [3].…”

“…Between 20 to 70% of patients with HZO presented with ocular involvement include blepharitis, keratoconjunctivitis, iritis, scleritis, and acute retinal necrosis [3]. In other words, orbital apex syndrome is characterized by dysfunction of ophthalmic division of trigeminal nerve (V), oculomotor nerve (III), trochlear nerve (IV), abducens nerve (VI) as well as optic nerve (II) [4]. Apart from aspergillosis and mucormycosis as common infectious causes for orbital apex syndrome, herpes zoster ophthalmicus also contribute to orbital apex syndrome; however, its occurrence is unusual.…”

“…A provisional diagnosis of right herpes zoster ophthalmicus with orbital apex syndrome was established and patient was started on treatment with intravenous acyclovir ter infections [4]. Concomitant involvement of dermatome supply by maxillary nerve in HZO is also possible (5.4%) [5].…”