Disorders of the Skin and Margin of the Eyelid 35 255 Herpes Zoster Ophthalmicus Definition

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Facial rash caused by the varicella-zoster virus.

Epidemiology: The disorder usually affects immunocompromised persons between the ages of 40 and 60 who have underlying disorders.

Etiology: The disorder is caused by the varicella-zoster virus, which initially manifests itself as chickenpox. If activation or reinfection occurs, the latent neurotropic viruses present in the body can lead to the clinical syndrome of herpes zoster ophthalmicus (Fig. 2.14).

Symptoms: The incubation period is 7-18 days, after which severe pain occurs in the area supplied by the first branch of the trigeminal nerve (the ophthalmic nerve with its frontal, lacrimal, and nasociliary branches). Prodromal symptoms of erythema, swelling, photosensitivity, and lacrimation may occur before the characteristic clear watery vesicles appear. The vesicles burst and brownish scabs form, which are later shed. Blepharitis (see p.33) is also present in 50-70% of all cases. As herpes zoster usually affects immunocom-

— Herpes zoster ophthalmicus.

— Herpes zoster ophthalmicus.

Herpes Eyelid Children

Fig. 2.14 The facial rash of herpes zoster is caused by the neurotropic varicella-zoster virus. After the clear watery vesicles burst, brownish scabs form, which are later shed.

promised persons, the patient should be examined for a possible underlying disorder.

H The skin sensitivity at the tip of the nose should be evaluated on both sides in the initial stage of the disorder. Decreased sensitivity to touch suggests involvement of the nasociliary branch of the ophthalmic nerve, which can lead to severe intraocular inflammation.

Treatment: This includes topical virostatic agents and systemic acyclovir.

Complications: Involvement of the nasociliary branch of the ophthalmic nerve can lead to severe intraocular inflammation.

Prognosis: The skin lesions heal within three to four weeks; scars may remain. Often neuralgiform pain and hypesthesia may persist.

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