Trigeminal Herpes Zoster: Keratitis, Uveitis
Inflammation of the cornea (keratitis) and of the iris and ciliary body (anterior uveitis) can complicate herpes zoster infection of the first trigeminal division.
Keratitis causes a foreign body sensation, photophobia, and blurred vision.
Uveitis causes photophobia and a sore eye. In either case, the conjunctiva may only be slightly inflamed. The redness typically appears near the corneal edge ("ciliary flush," "circumcorneal flush").
Zoster keratitis and uveitis may persist for months to years after the skin lesions have healed and cause lingering pain and visual difficulty.
What to do?
Refer for ophthalmologic consultation if the skin of the first trigeminal division is involved by zoster and especially if the patient complains of visual symptoms.
Prescribe acyclovir (800 mg 5x daily) prophylactically at first recognition of trigeminal zoster. This treatment reduces the likelihood of keratitis or uveitis if prescribed during the early phase of skin eruption.
Immunocompromised patients should be treated with intravenous acyclovir.