Abstract
Herpes zoster ophthalmicus usually manifests in elderly people as a unilateral painful skin rash in a dermatomal distribution of the ophthalmic division of the trigeminal nerve shared by the eye and ocular adnexa. It is the reactivation of varicella-zoster infection. Most common ocular manifestations of this disease include keratitis, conjunctivitis, and anterior uveitis. Severe hyphemia as a complication following herpes zoster uveitis is uncommon. We report a rare case of a 90-year-old lady with herpes zoster ophthalmicus and diabetes mellitus with unusually severe hyphemia. The disease responded well to systemic and topical steroids with improved vision outcome. Early referral to an ophthalmologist, detailed evaluation, and immediate treatment are mandatory to prevent permanent vision loss in these patients.
Highlights
Herpes zoster ophthalmicus (HZO) develops after the reactivation of varicella-zoster virus, typically affecting the ophthalmic division of trigeminal nerve, causing unilateral pain and pustular rash
The literature search (Pubmed, Science direct and Google scholar search) showed only three papers from Malaysia, of which one paper is on herpes zoster keratouveitis with hypopyon and hyphemia in 61 and 74 year old ladies [9], second paper is on herpes zoster keratouveitis and partial third nerve palsy in a 10 year old child [10], and third paper is on concurrent hyphemia and orbital apex syndrome following herpes zoster ophthalmicus in a 59 year old lady [11]
Fundoscopy showed mild nonproliferative diabetic retinopathy. We diagnosed her as having herpes zoster ophthalmicus with anterior uveitis and the patient was admitted in the eye ward
Summary
Herpes zoster ophthalmicus (HZO) develops after the reactivation of varicella-zoster virus, typically affecting the ophthalmic division of trigeminal nerve, causing unilateral pain and pustular rash. Ocular manifestations of HZO most commonly seen are keratitis, conjunctivitis, anterior uveitis and external ophthalmoplegia [1]. Involvement of the tip of the nose which represents the dermatome of nasociliary nerve is classically known as Hutchinson’s sign; ocular involvement is more common in such cases, and urgent ophthalmological consultation is required [3]. In cases of herpes zoster anterior uveitis, hyphema as a complication has been reported in a few cases [4]-[8] from different countries. We report a case of herpes zoster ophthalmicus with iridocyclitis and hyphema in a very elderly (90 years old) lady with diabetes mellitus, in view of its rare occurrence
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