Herpes Zoster Ophthalmicus
When herpes zoster involves CN V dermatomes, pain may arise in the affected region days before a vesicular eruption appears (Fig 12-3). The pain is described as aching or burning. Occasionally, no vesicles are apparent (zoster sine herpete). Acutely, the pain may be exacerbated by concomitant iritis. The pain may persist long after resolution of the acute infection (postherpetic neuralgia), and it can be extremely discomforting and difficult to treat. Pregabalin, gabapentin, tricyclic antidepressants, and topical 5% lidocaine patches may be effective for some patients. Treatment with antiviral drugs during the acute phase may decrease the risk of severe postherpetic neuralgia. The zoster vaccine, offered to immunocompetent persons aged 60 years and older, significantly reduces the incidence of herpes zoster and markedly decreases the incidence and morbidity of postherpetic neuralgia. (See Chapter 7 in BCSC Section 9, Uveitis and Ocular Inflammation, for further discussion on herpes zoster.)
Oxman MN, Levin MJ, Johnson GR, et al; Shingles Prevention Study Group. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005; 352(22):2271–2284.
Excerpted from BCSC 2020-2021 series: Section 5 - Neuro-Ophthalmology. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.