Diagnosis: Herpes zoster ophthalmicus
Grouped herpetiform vesicles on an erythematous base and orbital edema confined to the cutaneous surface innervated by the ophthalmic branch of the fifth cranial nerve
Grouped herpetiform vesicles on an erythematous base and orbital edema confined to the cutaneous surface innervated by the ophthalmic branch of the fifth cranial nerve
Submitted by Alaa Saad. Originally posted August 31, 2010.
See case discussion.
• Herpes simplex • Contact dermatitis • Cellulitis • Bullous impetigo • Dermatitis herpetiformis • Drug eruption • Insect bites
• Reactivation of varicella-zoster virus (VZV) from dorsal root ganglia • Dermatomal distribution that does NOT cross the midline is the hallmark • Hutchinson sign: vesicles on tip of nose → nasociliary branch of V1 → ophthalmologic emergency • Ramsay Hunt syndrome: VZV in geniculate ganglion → facial palsy + ear vesicles + otalgia • Post-herpetic neuralgia (PHN) is the most common complication — risk increases with age • Shingrix vaccine (recombinant) >90% effective at preventing zoster — recommended for adults ≥50
Tags: herpes, zoster, ophthalmicus, alaa saad