eye disorders
Herpes Zoster Ophthalmicus
Introduction
Herpes zoster ophthalmicus is a reactivated latent varicella-zoster virus (VZV) infection ( Herpes Zoster ) involving the eye. Symptoms and signs, which may be severe, include unilateral dermatomal forehead rash and painful inflammation of all the tissues of the anterior and, rarely, posterior structures of the eye. Diagnosis is based on the characteristic appearance of the anterior structures of the eye plus ipsilateral zoster dermatitis of the first branch of the trigeminal nerve (V1). Treatment is with oral antivirals, mydriatics, and topical corticosteroids. After the primary infection, latency is established in the sensory ganglion. VZV-specific T cell–mediated immunity maintains VZV in the latent state. Viral reactivation results when immunity declines due to age, illness, or immunosuppression. Herpes zoster of the forehead involves the globe in three fourths of cases when the nasociliary nerve is affected (as indicated by a lesion on the tip of the nose) and in one third of cases not involving the tip of the nose. Overall, the globe is involved in half of patients. Varicella zoster virus is highly contagious and transmission may occur by direct contact with an ulcerated skin lesion or airborne aerosols. 