Zoster ophthalmicus B02.3

Zoster localized in the innervation area of the 1st trigeminal branch, infestation of the ganglion ciliare. Frequently haemorrhagic-necrotic course in the area of the forehead and capillitium. Risk of involvement of conjunctiva and cornea. Zoster ophthalmicus is more frequent in HIV-infected persons than in non-infected persons (Johnson JL et al. 2015).

Zoster in the area of the first trigeminal branch accounts for up to 18% of all zoster cases.

Incubation period 7-18 days. Uncharacteristic prodromal stage with slightly elevated temperature. Burning and stabbing, shooting pains in the area of the 1st trigeminal branch may occur even before the typical skin symptoms appear. Later on, grouped standing papules on an erythematous ground are shot up with rapid transformation into initially clear, later cloudy blisters, pustules and later crust formation. Rare hemorrhagic-necrotic zoster. Scarring especially in necrotizing zoster.

Remember! Ophthalmological complications are to be expected in the case of blisters in the nasal-ocular triangle area (infestation of the ramus nasociliaris of the ophthalmic nerve).

S.a. Hutchinson's sign II (zoster blisters at the tip of the nose, 75% eye involvement).

Post-zosteric neuralgia (can considerably reduce the quality of life of those affected): about 10-30% of all >50-year-olds suffer from post-zosteric neuralgia. This is defined as "pain occurring 3 months after the typical skin changes". The pain is perceived differently, as:

• constantly persistent

• recurrent

• also shooting in like lightning (as with light currents)

• allodynically occurring at the slightest touch.

Studies on larger contingents of Zoster-ophthalmicus patients showed that within a one-year follow-up the risk of stroke is significantly higher than in a control group ( Hazard Ratio = 4.52).

• According to the zoster, ophthalmological presentation of the patient, antiviral, possibly antibiotic local therapy (Zovirax eye ointment, Refobacin eye ointment), light protection.
• Pain therapy: sympathetic nerve blockage (in case of infestation of the 1st and 2nd trigeminal branch, blockage of the superius cervical ganglion), see also zoster neuralgia.

See below Zoster (overview). Possibilities of vaccination with live vaccine or a recombinant vaccine.

1. Lin HC et al (2010) Herpes zoster ophthalmicus and the risk of stroke: a population based follow-up study. Neurology 74: 792-797

2. Johnson JL et al (2015) Herpes Zoster Ophthalmicus.
   Prim Care 42:285-303.

3. Lovell B (2015) Trigeminal herpes zoster: early recognition and treatment are crucial. BMJ Case Rep doi:10.1136/bcr-2014-208673

4. Ostwal S et al (2015) Management of ramsay hunt syndrome in an acute palliative care setting. Indian J Palliat Care 21:79-81