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HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

■ Preauricular adenopathy

■ Corneal haziness

■ Classic dendritic (branching) ulcer

TREATMENT

■ Prompt ophthalmology consult

■ Topical trifluridine or oral acyclovir

■ Topical cycloplegic if associated iritis

■ Topical steroids may be used but only in conjunction with antiviral therapy

and typically only by an ophthalmologist.

Herpes Zoster Ophthalmicus

ETIOLOGY

Reactivation of latent varicella zoster virus (also known as shingles) in trigeminal

ganglion

SYMPTOMS/EXAM

■ Pain, paresthesia, tearing

■ Unilateral vesicular eruption with dermatomal distribution (usually V1)

■ Occular involvement varies (conjunctivitis, iritis, keratitis, muscle

palsies,etc.).

■ Hutchinson sign: Herpetic vesicle on the tip of the nose indicating

nasocilliary nerve involvement and likelihood of ocular involvement (see

Figure 14.36).

■ Pseudodendritric ulcer with fluorescein staining

FIGURE 14.36. Herpes zoster ophthalmicus with Hutchinson sign.

(Reproduced, with permission, from Wolff K, Johnson RA, Suurmond D. Fitzpatrick’s Color

Atlas & Synopsis of Clinical Dermatology, 5th ed. New York: McGraw-Hill, 2005:825.)