HERPES ZOSTER OPHTHALMICUS OF THE RIGHT EYE INVOLVING THE OPHTHALMIC BRANCH OF THE TRIGEMINAL NERVE: A RARE CASE REPORT
Authors: ANIMESH DAS, Satheesh E Kumar
Keywords: Herpes Zoster, ophthalmology, trigeminal nerve, varicella-zoster virus
Abstract:
This case describes the clinical features, investigations, and management of Herpes Zoster Ophthalmicus (HZO), a viral infection affecting the ophthalmic division (V1) of the trigeminal nerve. The patient presented with multiple fluid-filled lesions on the right side of the face for two days, fever for three days, pain, burning sensation on the right side of the face, headache, neck pain, giddiness for one day, and burning with blurred vision in the right eye. On examination, there was swelling of the right eyelid and conjunctival redness, suggestive of eye involvement. The patient was admitted to the dermatology department for further care. Blood investigations showed haemoglobin 14.9 g/dL, red blood cells 5.45 million/cumm, hematocrit 46.9%, platelets 2.50 lakhs/cumm, and white blood cell count 8540 cells/cumm, with neutrophils 67%, lymphocytes 21%, monocytes 11%, eosinophils 1%, and basophils 0. The patient had no history of eye discharge, hearing problems, seizures, unconsciousness, facial weakness, or other comorbid conditions. His history included recurrent headaches for two years, treated with medications. He had already taken acyclovir 800 mg before admission. The patient underwent relevant investigations, and encephalitis was ruled out by the medicine team. An ophthalmology opinion was taken to assess ocular complications. Conservative management was planned, and antiviral therapy with acyclovir was continued. Herpes Zoster Ophthalmicus occurs due to reactivation of the varicella-zoster virus (VZV), which belongs to the genus Varicellovirus. Reactivation can cause direct viral damage, immune-mediated inflammation, or occlusive vasculitis (blockage of blood vessels). Treatment mainly involves early initiation of antiviral drugs, such as acyclovir, and in some cases, corticosteroids to reduce inflammation. Prompt treatment helps prevent serious complications, including vision loss, and improves overall recovery.
