Introduction

Herpes zoster ophthalmicus (HZO) describes the reactivation of the varicella zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve. It accounts for around 10% of case of shingles.

Epidemiology

  • Incidence: 20.00 cases per 100,000 person-years
  • Peak incidence: 60-70 years
  • Sex ratio: 1:1
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Clinical features

Features
  • vesicular rash around the eye, which may or may not involve the actual eye itself
  • Hutchinson's sign: rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement

Management

Management
  • oral antiviral treatment for 7-10 days
    • ideally started within 72 hours
    • intravenous antivirals may be given for very severe infection or if the patient is immunocompromised
    • topical antiviral treatment is not given in HZO
  • topical corticosteroids may be used to treat any secondary inflammation of the eye
  • ocular involvement requires urgent ophthalmology review

Complications

Complications
  • ocular: conjunctivitis, keratitis, episcleritis, anterior uveitis
  • ptosis
  • post-herpetic neuralgia