Orbital Apex Syndrome Secondary to Herpes Zoster Ophthalmicus

Abstract

Orbital apex syndrome is a rare complication of herpes zoster ophthalmicus. In addition to our case, we review the clinical presentation, imaging findings, treatment options, and prognosis of 14 other reported cases. Magnetic resonance imaging of our patient demonstrated diffuse enhancement of the orbit involving the orbital apex, optic nerve and/or nerve sheath, extraocular muscles, and orbital soft tissues. There was significant clinical improvement with acyclovir and systemic corticosteroids, which seems to be preferred treatment for this disorder.

Orbital apex syndrome as a complication of herpes zoster ophthalmicus

“…Age and diabetes are possible triggers for reactivation of herpes virus in our case. Aseptic meningitis has been reported in 88% of cases 5. However, there were no meningeal signs in our patient.…”

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

“…Neurologic manifestations are present in 5%–10% of HZO patients. [ 2 ] The most common neurologic manifestations include cerebellar ataxia, meningoencephalitis, post-herpetic neuralgia, cranial nerve palsies. [ 2 ] OAS secondary to HZO is very rare and only a handful of reports are present in the English literature.…”

“…[ 2 ] The most common neurologic manifestations include cerebellar ataxia, meningoencephalitis, post-herpetic neuralgia, cranial nerve palsies. [ 2 ] OAS secondary to HZO is very rare and only a handful of reports are present in the English literature. [ 3 ] OAS, defined as variable degree of involvement of oculomotor, trochlear, abducens, ophthalmic division of trigeminal cranial nerves and of the optic nerve is a rare HZV complication.…”

“…Among those, only three patients developed OAS after instituting oral acyclovir, as seen in our case. [ 2 ]…”

“…[ 1 ] In a recent review of cases of orbital apex syndrome (OAS) secondary to varicella zoster virus (VZV), the authors found only 15 such cases over 5 decades (1966–2015). [ 2 ] We present a case of unilateral OAS and anterior cavernous syndrome (ACS) secondary to VZV leading to complete irreversible blindness.…”