An 82 year old woman has developed a painful blistering rash on one side of her forehead and anterior scalp. She also has a red eye, decreased visual acuity and epiphora alongside the forehead tenderness. What is the SINGLE most likely nerve affected?
A. Accessory nerve
B. Facial nerve
C. Olfactory nerve
D. Optic nerve
E. Trigeminal nerve
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus (HZO) describes the reactivation of the varicella zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve. It accounts for around 10-20% of case of shingles.Ophthalmic herpes is a danger to sight and the patient should see an ophthalmologist the same day.
Features - Vesicular rash around the eye, which may or may not involve the actual eye itself
- Hutchinson’s sign: rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement
Management - Oral antiviral treatment - Oral corticosteroids may reduce the duration of pain - Ocular involvement requires urgent ophthalmology review
Complications - Ocular: conjunctivitis, keratitis, episcleritis, anterior uveitis - Ptosis - Post-herpetic neuralgia
Keratitis is a condition in which the eye’s cornea, the front part of the eye, becomes inflamed. Another infectious cause of keratitis is Herpes simplex keratitis in which case presents with a dendritic corneal ulcer. For herpes simplex keratitis, topical acyclovir is used