A 30 year old male presents with unilateral painful skin rash in a dermatomal distribution of ophthalmic branch of trigeminal nerve including tip of nose. Most common finding in such a case will be :-
- Pseudodendritic keratitis
- Punctate epithelial keratitis
- Serpiginous ulceration
- Neurotrophic keratopathy
View Explanation
Herpes Zoster Ophthalmicus is an ocular disease which usually manifests as a unilateral painful skin rash in a dermatomal distribution of the trigeminal nerve shared by the eye and ocular adnexa. HZO occurs typically in older adults but can present at any age and occurs after reactivation of latent varicella-zoster virus (VZV).
HZO is caused by the varicella-zoster virus which has re-activated from its dormant status in the dorsal ganglion cells of the central nervous system From there it may travel along neurons to the sensory axons of the skin to form vesicular lesions.
Erythematous skin lesions with macules, papules. vesicIes, pustules, and crusting lesions in the distribution of the trigeminal nerve. Hutchinson’s sign is defined as skin lesions at the tip, side, or root of the nose This is a strong predictor of ocular inflammation and corneal denervation in HZO, especially if both branches of the nasociliary nerve are involved as seen in the case.
Oral acyclovir 800 mg po five times daily for 7 to 10 days is the standard treatment. Alternatively, a provider could use famciclovir 500 mg po tid or valacyclovir 1000mg po tid. If the systemic condition warrants or if the patient is unable to tolerate food by mouth then acyclovir 5-10 mg/kg iv q8 for 5 days may be utilized.
Frequency of various corneal changes in Herpes Zoster Ophthalmicus:
Punctate epithelial keratitis — 50% — most common
Pseudodendritic keratitis— 50%
Anterior stromal keratitis — 40%
Keeratouveitis endothelitis — 34%
Serpiginous ulceration —7%
Sclerokeratitis — 1%
Corneal mucous plaques - 13%
Disciform keratitis — 10%
Neurotrophic keratopathy — 25%
Exposure keratopathy — 11%
Interstitial keratitis I lipid keratopathy — 15%
Permanent corneal edema —5%