B02.2* + (G53.0*)
DESCRIPTION
Herpes zoster ophthalmicus occurs when the varicella-zoster virus reactivates in the trigeminal ganglion and passes down the ophthalmic division of the trigeminal nerve. Patients present with a painful vesicular rash in the trigeminal V1 area – vesicles on the tip of the nose indicate nasociliary branch involvement, which increases the risk of ocular involvement. A minority of patients may develop conjunctivitis, keratitis, uveitis, retinitis, and cranial nerve involvement (oculomotor or optic nerves). Permanent sequelae of ophthalmic zoster infection may include chronic ocular inflammation, loss of vision, and debilitating post-herpetic neuralgia. All patients should be offered HIV testing.
MEDICINE TREATMENT
- Aciclovir, oral, 800 mg 4 hourly while awake for 7–10 days.
Note: Treatment should be initiated within the first three days of onset of symptoms, except in HIV-infected patients who should be treated if there are active skin lesions.
Post-herpetic neuralgic:
Initiate treatment with adjuvant therapy (i.e.amitriptyline) early.
See : Management of neuropathic pain (Post-herpetic neuralgia).
REFERRAL
- Vesicles at the tip of the nose.
- Fluorescein staining of cornea shows corneal/ulceration.
- Decreased vision.
- Red eye (uveitis or keratitis).
- Cranial nerve palsies.