58-year old lady presented with right sided facial pain of three days duration. She had noted skin eruptions over the right side of forehead and right upper eyelid. Drooping of right upper eyelid was also noted. She was a diabetic.
On examination, vesicular eruptions were noted in the distribution of right V1- ophthalmic division of right trigeminal nerve. Redness and local tenderness were present. There was mechanical ptosis on the right side due to edema of eyelids.
A diagnosis of right sided herpes zoster ophthalmicus (HZO) was made. HZO is thought to occur due to reactivation of varicella zoster virus in the dorsal nerve root or sensory ganglion. The diagnosis of HZO can be made on the basis of clinical examination and no tests are generally needed. She was started on acyclovir and analgesics.
Most patients with herpes zoster ophthalmicus have a good outcome, especially if acyclovir is started within 72 hours of symptom onset. Some patients can develop ocular complications, visual loss and post-herpetic neuralgia (chronic pain in the affected area).