Herpes zoster ophthalmicus

Abstract

A 65 year old woman attends your practice with a two day history of a vesicular rash around her right eye. She also reports a general feeling of fatigue and malaise and has been slightly feverish over the past week. She had noticed a pain around her right eye even before the skin eruption began. ### What is it and why has she got it? After an attack of chickenpox the virus (varicella zoster) remains dormant in the body. This virus is kept in check by the immune system. However, in 20% of people the virus is reactivated, resulting in a localised painful rash with blisters (shingles). The commonest cause is a weakening of the immune system with age; most patients are aged over 50 years. Other causes include stress, fatigue, and a weakening of the immune system from other illnesses or from medical treatment (such as chemotherapy or immunosuppression). When the eruption involves the area around the eye (the ophthalmic or first division of the trigeminal nerve), this is called herpes zoster ophthalmicus, irrespective of whether the actual eye itself is involved. Ophthalmic herpes zoster accounts for 10-25% of all cases of shingles. ### Have I got the right diagnosis? The main differential diagnosis is herpes simplex infection. In herpes simplex the patients are usually young, and the rash will not follow a dermatome, nor will …