Herpes zoster ophthalmicus

What you need to know Offer patients systemic antiviral medication to reduce complications, notably corneal complications and potentially post-herpetic neuralgia Herpes zoster ophthalmicus may directly involve the eye and/or the skin around the eye, or may occur without ocular involvement, where only the skin of the V1 dermatomal region is affected Refer to ophthalmology if a patient has ocular symptoms or signs A 70 year old man attended with a two day history of painful vesicular rash affecting the left forehead accompanied by a red, painful left eye. Starting oral antiviral treatment within 72 hours of the onset of rash substantially reduces the risk of long term ocular complications such as corneal pseudo-dendrites, stromal keratitis, and uveitis.3 However, a recent Cochrane review has shown that starting oral antiviral treatment within 72 hours may reduce the severity but not the incidence of post-herpetic neuralgia.45 Is there any pain affecting the eye or the periocular skin? Studies have shown that shingles vaccination, which contains live attenuated varicella zoster virus, may rarely result in reactivation of herpes zoster ophthalmicus.6 Social history Is there any recent contact with patients affected by chickenpox or herpes zoster infection? Acute medicine/infectious disease team—consider referring patients to secondary care in hospital for assessment and intravenous antiviral treatment in the following circumstances8: involvement of central nervous system (eg, reduced mental status) elderly patients with severe disease (eg, multi-dermatomal involvement) immunosuppressed patients those who cannot take oral medication. those with acute retinal necrosis.