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Herpes zoster ophthalmicus with trochlear nerve involvement after alcohol injection into the Gasserian ganglion.

Herpes zoster wherein the trigeminal ganglion is affected was first described by Jonathan Hutchinson (i869), but to this day many aspects of the disease are not fully understood. The virus of zoster seems to be identical with varicella virus yet the clinical manifestations differ markedly. In the past, two types of zoster were thought to exist; idiopathic (epidemic) and symptomatic (secondary) (Duke-Elder, I965). It is not sufficiently widely appreciated that all zoster is due to reactivation of latent virus. What makes the virus replicate is still often obscure. What are the reactivating factors, and what mechanisms are involved? In herpes zoster ophthalmicus (HZO), the nerves to the ocular muscles are occasionally involved, the 3rd most commonly, followed by the 6th nerve, the 4th nerve being the rarest (Edgerton, I945). The factors responsible for such involvement have not been identified with any certainty. A case is here described of a woman who developed HZO after an alcohol injection into the ipsilateral Gasserian ganglion for "tic douloureux". Subsequently the trochlear nerve on that side became involved. The purpose of this paper is to suggest the existence of a correlation between these events and thereby to shed some light on the questions posed above.