Occurs when Varicella Zoster Virus reactivates in the trigeminal ganglion and passes down the ophthalmic division of the trigeminal nerve
Diagnostic Criteria
- Presents with painful vesicular rash in the trigeminal V1 area–vesicles on the tip of the nose indicate nasociliary branch involvement and increases the risk of ocular involvement
- Some patients develop conjunctivitis, keratitis, uveitis, retinitis and cranial nerve involvement (oculomotor and optic nerves)
- Later, chronic ocular inflammation, loss of vision, post herpetic neuralgia
- All patients should be offered HIV testing
Pharmacological Treatment
B: Acyclovir (PO) 800 mg 4 hourly for 7–10 days
AND
A: Amitriptyline (PO) 25 mg at night for 3 months.
Note: Treatment should be initiated within 3 days of the onset of symptoms, except in HIV infected patients who should be treated if there are active skin lesions
Referral
Refer to eye specialist in case of:
- Vesicles on the tip of the nose
- Fluorescein staining of the cornea shows corneal ulceration
- Decreased vision
- Red eye (uveitis or keratitis)
- Cranial nerve palsies
