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Emergency: requires immediate attention
Herpes zoster ophthalmicus in Child
See also in: External and Internal Eye
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Other Resources UpToDate PubMed
Emergency: requires immediate attention

Herpes zoster ophthalmicus in Child

See also in: External and Internal Eye
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Contributors: Brandon D. Ayres MD, Christopher Rapuano MD, Sunir J. Garg MD, Lauren Patty Daskivich MD, MSHS
Other Resources UpToDate PubMed

Synopsis

Herpes zoster ophthalmicus (HZO) is a reactivation of a latent infection with the varicella-zoster virus (VZV) in the distribution of the ophthalmic branch of the trigeminal nerve (V1). Classically, this reactivation occurs in healthy patients in or beyond their sixth decade. HZO is also more common in patients who are debilitated due to illness, trauma, stress, or immunosuppression (secondary to chemotherapy / medications, human immunodeficiency virus [HIV] infection, radiation, malignancy, etc).

Early symptoms include dysesthesias of the forehead and brow, along with headache, fever, fatigue, and eye pain. A vesicular rash that respects the midline can then develop, involving the forehead, brow, and eyelids. Involvement of the tip of the nose (Hutchinson sign) increases the chances of ocular involvement by up to 75%. The rash can be quite severe or mild enough to be mistaken for acne.

A red eye on the involved side indicates ocular involvement. HZO often causes conjunctivitis and can involve other structures of the eye, causing keratitis, scleritis, uveitis, cranial nerve palsies, and, less commonly, retinitis and optic neuritis. Symptoms include eye pain, tearing, redness, and decreased vision.

Once the acute phase of HZO has healed, a chronic inflammatory course with frequent exacerbations can persist, causing progressive corneal scarring and neurotrophic keratoconjunctivitis. Long-term complications also include ocular hypertension, glaucoma, and cataract. Chronic recurrent HZO (long after the rash has healed) can be very difficult to treat and may lead to corneal scarring and neovascularization. Postherpetic neuralgia can also be a very difficult situation for both patients and physicians to deal with. Cerebrovascular accidents have been associated with zoster.

Codes

ICD10CM:
B02.30 – Zoster ocular disease, unspecified

SNOMEDCT:
87513003 – Herpes zoster ophthalmicus

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Differential Diagnosis & Pitfalls

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Therapy

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Last Reviewed: 08/14/2019
Last Updated: 08/27/2019
Copyright © 2019 VisualDx®. All rights reserved.
Emergency: requires immediate attention
Herpes zoster ophthalmicus in Child
See also in: External and Internal Eye
Print 8 Images
View all Images (8)
(with subscription)
Herpes zoster ophthalmicus (Prodrome) : Fever, Headache, Corneal dendritic ulcer, Malaise, Unilateral, Ocular pain
Clinical image of Herpes zoster ophthalmicus
Copyright © 2019 VisualDx®. All rights reserved.