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Zoster Ophthalmicus

What is Zoster Ophthalmicus?

  • Zoster Ophthalmicus (HZO) is a reactivation of the varicella-zoster virus (VZV) affecting the eye.
  • It involves the ophthalmic (V1) branch of the trigeminal nerve.
  • Presents as painful unilateral rash on forehead/eye region with ocular involvement.
  • Considered an ophthalmic emergency due to risk of vision loss.
  • Caused by reactivation of latent VZV (after chickenpox).
  • Virus remains dormant in sensory nerve ganglia → reactivates → travels along nerves to skin and eye.
  • Leads to: Skin lesions (vesicles), Ocular inflammation.

Symptoms of Zoster Ophthalmicus

  • Fever, malaise
  • Headache
  • Pain/tingling in forehead or eye area

Complications of Zoster Ophthalmicus

  • Keratitis (corneal inflammation)
  • Uveitis
  • Glaucoma (↑ intraocular pressure)
  • Optic nerve damage
  • Permanent vision loss
  • Postherpetic neuralgia (chronic pain)
  • Retinal necrosis (rare but severe)

Diagnosis of Zoster Ophthalmicus

  • Primarily clinical diagnosis: Dermatomal rash + eye symptoms
  • Tests (if unclear): PCR, Viral culture, Serology 

Treatment of Zoster Ophthalmicus

  • Oral antivirals: Acyclovir, Valacyclovir, Famciclovir
  • Topical corticosteroids (for inflammation)
  • Mydriatic drops (pain relief, prevent complications)
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