Ophthalmic Zoster: Common Manifestation in the Elderly

Periorbital, forehead, and nasal erythema, crusting, and pain typical of herpes zoster affected a 90-year-old woman. Reactivation of the latent varicella zoster is more common in the elderly and is attributed to impaired immunologic mechanisms.

This patient was referred for ophthalmologic consultation because the eye showed moderate right bulbar conjunctival injection. No viral ocular involvement was noted; irritation was caused by rubbing the eye. No specific ophthalmic treatment was prescribed.

Robert P. Blereau, MD of Morgan City, La, writes that any or all of the ophthalmic nerve branches may be involved in patients with herpes zoster. Between 20% and 72% of patients experience ocular complications; anterior uveitis and keratitis are the most common disorders.¹ The most serious ocular conditions, including conjunctival, scleral, and corneal diseases, result with involvement of the side and tip of the nose innervated by the nasociliary nerve branch. Prompt treatment reduces the severity of the dermatitis, the incidence and severity of late ocular complications, and the pain of postherpetic neuralgia. This patient was given oral valacyclovir, 1 g tid for 1 week. The dermatitis dried and resolved with minimal pain; no analgesics were required.

REFERENCE:1. Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 3rd ed. St Louis: Mosby; 1996:354-355.