Maxillary Zoster and Neurotrophic Keratitis following Trigeminal Block

Abstract

Herpes zoster ophthalmicus is commonly used to describe viral reactivation from the trigeminal ganglia with ocular involvement. The ophthalmic branch is the most commonly involved, whereas the maxillary and mandibular dermatomes are less commonly affected. Neurotrophic ulcer may occur secondary to intentional or inadvertent damage to the trigeminal nucleus, root, ganglion, or any segment of the ophthalmic branch of this cranial nerve. We report a case of reactivated maxillary herpes zoster combined with neurotrophic keratitis due to percutaneous 2nd and 3rd branch of trigeminal nerve block with alcohol to treat trigeminal neuralgia. A 57-year-old female came to the ophthalmology department complaining of decreased visual acuity and skin vesicle over the right lower lid and cheek. She had undergone right trigeminal nerve block for treatment of trigeminal neuralgia. Clinical examination revealed neurotrophic keratitis and maxillary herpes zoster. She was treated with oral and topical antivirals and vigorous lubrication with eye drops. Her neurotrophic keratitis showed a slow recovery. Although a few cases of herpes zoster following nerve block have been described, it would appear that a case of simultaneous maxillary herpes zoster and neurotrophic keratitis following trigeminal block has not yet been documented. It is possible that trigeminal nerve block may cause reactivation of latent virus and refractory neurotrophic keratitis.

A misdiagnosed patient with an erythematous rash covering the half of his midface

“…The predisposing conditions involve malnutrition, (long-term) corticosteroid therapy, cytotoxic medications, radiotherapy, chemotherapeutic agents, diabetes, chronic obstruc-tive pulmonary disease, malignant disease, and immune disorders (2). Reactivated maxillary HZ combined with neurotrophic keratitis has been reported after percutaneous block with alcohol, used for the treatment of trigeminal neuralgia, in the area of 2nd and 3rd branches of trigeminal nerve (1). The clinical course of HZ is separated into three consecutive stages: the prodromal, acute, and chronic neuropathic (8).…”