J Korean Ophthalmol Soc.  2015 May;56(5):789-793. 10.3341/jkos.2015.56.5.789.

A Case of Multiple Complications in Herpes Zoster Ophthalmicus

• Son YW
• Kim JH
• Lee SW

• KMID: 2121182
• DOI: http://doi.org/10.3341/jkos.2015.56.5.789

Abstract

PURPOSE
We report a case of stromal keratitis, corneal infiltration, anterior uveitis, central retinal artery occlusion and optic neuropathy in a patient with herpes zoster ophthalmicus.
CASE SUMMARY
A 73-year-old man who was hospitalized for pain and vesicles on his left face was referred to our clinic with sudden onset visual disturbance in his left eye. His best corrected visual acuity in the right eye was 0.8 and light-perception in his left eye. Relative afferent pupillary defect was found in his left eye. Slit-lamp examination showed anterior uveitis secondary to herpes zoster ophthalmicus presented with stromal keratitis. Fundus examination showed retinal hemorrhage, vitreous opacity, cherry-red spot in the fovea and optic disc swelling. Delayed arterial filling and arteriovenous transit time were observed on fluorescence angiography. He was treated with topical antiviral and steroid eye drops for stromal keratitis and anterior uveitis. He was also treated systemically with an intravenous antiviral agent and oral steroid, but visual acuity did not improve.
CONCLUSIONS
Stromal keratitis, corneal opacity, anterior uveitis, central retinal artery occlusion and optic neuropathy can be complications of herpes zoster ophthalmicus.

Keyword

Central retinal artery occlusion; Herpes zoster ophthalmicus; Optic neuropathy; Stromal keratitis

MeSH Terms

Aged
Corneal Opacity
Fluorescein Angiography
Herpes Zoster Ophthalmicus*
Humans
Keratitis
Ophthalmic Solutions
Optic Nerve Diseases
Pupil Disorders
Retinal Artery Occlusion
Retinal Hemorrhage
Uveitis, Anterior
Visual Acuity
Ophthalmic Solutions

Figure

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  Figure 1. Photograph of patient showing vesicle and crust in left ophthalmic branch of trigeminal nerve dermatome with lesions on tip of the nose (Hutchinson’s sign).

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  Figure 2. At the first visit. (A) The left eye showed corneal edema and stromal keratitis. (B) Slit lamp photograph of the left eye; anterior chamber reaction and keratic precipitates on the corneal endothelium.

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  Figure 3. (A) Fundus photograph of the left eye showing retinal hemorrhages, disc edema and macular opacification with a cherry-red spot at the initial visit. (B) Six months later, fundus photograph of the left eye shows narrowing of the retinal arteries and optic disc pallor.

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  Figure 4. Fluorescein angiography of the left eye at the initial visit. (A) At 29 seconds after injection, filling of arterioles are still incomplete. (B) At 55 seconds after injection, filling of retinal vein is still incomplete. The left eye shows a delayed arm-to-retinal circulation and arteriovenous transit time.

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  Figure 5. Magnetic resonance imaging shows slightly enhanced left optic nerve after contrast injection on T2-weighted image (white arrowhead).

Reference

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