Abstract
A healthy 73-year-old man was seen at the eye casualty department of the Leicester Royal Infirmary, Leicester, England, with herpes zoster ophthalmicus and a visual acuity of counting fingers in the right eye and with a visual acuity of 20/30 OS. At this time, his pupil reactions and discs were normal. A diagnosis of herpes zoster keratouveitis was made, and oral treatment with acyclovir was commenced. One month later his rash was resolving, the keratouveitis had cleared, and his visual acuity had improved to 20/40 OD and 20/30 OS. Pupil reactions and fundus appearance remained normal, but he had severe postherpetic neuralgia. Two months after the initial visit, sudden-onset vertical diplopia developed and he was found to have a right fourth nerve palsy, which was attributed to herpes zoster. Five months after his initial visit, he returned with a 2-day history of reduced visual acuity in the right eye. His
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