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14.6 Herpes Zoster Ophthalmicus

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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


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


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

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