Etiology: Proceeding from the trigeminal ganglion, the virus reinfects the region supplied by the trigeminal nerve. The eye is only affected where the ophthalmic division of the trigeminal nerve is involved. In this case, the nasociliary nerve supplying the interior of the eye will also be affected. Hutchinson's sign, vesicular lesions on the tip of the nose, will be present (see Fig. 2.14).
Diagnostic considerations: Herpes zoster ophthalmicus also occurs in superficial and deep forms, which in part are similar to herpes simplex infection of the cornea (red eye with dendritic keratitis, stromal keratitis, and ker-atouveitis). Corneal sensitivity is usually decreased or absent.
Treatment: The eye is treated with acyclovir ointment in consultation with a dermatologist, who will usually treat skin changes with systemic acyclovir (in the form of infusions or tablets). If the corneal epithelium is intact, the irritation of the anterior chamber can be carefully treated with steroids and immobilization of the pupil and ciliary body by therapeutic mydriasis.
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