Sixth nerve palsy and keratouveitis in patient with varicella zoster virus reactivation posterior to COVID-19 vaccine

Abstract

Background: We present a case of herpes zoster-induced by the COVID-19 vaccine, with present sixth nervepalsy and keratouveitis. Case presentation: A 77-year-old patient presented to the hospital with a right-sided headache, dysesthesiasin the trigeminal territory, diplopia, and restricted abduction in the right eye. She had been vaccinated with the Pfizer/BioNTech vaccine three weeks prior. Examination revealed the weakness of abduction and elevated intraocular pres-sure of the right eye. Brain imaging tests were normal. At follow-up, a pseudo-dendritic corneal ulcer and iridocyclitiswere noted. The polymerase chain reaction of aqueous humor confirmed the diagnosis of herpes zoster ophthalmicus.Treatment with oral valacyclovir and topical prednisolone was started, with gradual improvement of the symptoms.conclusIon:Herpes zoster is an uncommon cause of sixth nerve palsy. The association between the COVID-19vaccine and increased incidence of herpes zoster has recently been described. Awareness must be created for promptdiagnosis and treatment.