Herpes Zoster Ophthalmicus (HZO)

Ophthalmic shingles, affecting the ophthalmic branch of the trigeminal nerve, can have sight threatening complications.

When a patient has ophthalmic shingles it is important to decide whether the eye itself is involved. There are 3 key clues to ocular involvement

  1. Reduced Vision
  2. Photophobia
  3. Nasociliary Nerve involved with rash to the tip of the nose. (hutchinsons sign)

Any of these should prompt referral to an eye department, where the patient may be likely to require steroid eye drops for some months. If the vision is normal, with no photophobia and the rash spares the nose, then treat with antivirals and safety net for visual changes as above.

With regards HZO, which of the following are true?

  • Should always be referred to an eye department
  • Should always receive antivirals such as aciclovir
  • Always affects the nose
  • Never crosses the midline

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