Purchase this article with an account.
Renelle Pointdujour, Jenny Temnogorod, Ronald Mancini, Shu-Hong Chang, Bita Esmaeli, Roman Shinder; Acute Orbital Syndrome in Herpes Zoster Ophthalmicus. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4082.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Herpes Zoster Ophthalmicus (HZO) is a fairly common condition that has a spectrum of clinical manifestations. However, an acute orbital syndrome with corresponding findings on radiography is exceedingly rare with only a few case reports in the literature. We detail 6 such cases.
Six patients with HZO with acute orbital findings were reviewed. Clinical presentation, radiography, and treatment outcomes were assessed.
Patient demographics and outcomes are summarized in Table 1. One man and 5 women with a median age of 71 (range 47-84) presented with HZO with acute clinical orbital signs. Two of the six patients had compromised immune systems, with one patient having Chronic Lymphocytic Leukemia (CLL) and another infected with HIV. Clinical orbital findings included proptosis, blepharoptosis, ophthalmoplegia, diplopia, and visual loss. Orbital imaging detailed such findings as myositis in all 6 patients, dacryoadenitis in 2 patients (Fig 1), and optic nerve sheath enhancement in 1 patient. Treatment with IV acyclovir was universal in all 6 patients, and in 1 case systemic glucocorticoids were also given for multiple cranial neuropathy. The orbital syndrome in all patients improved over several months with preserved visual function, except in 1 patient who developed a posterior uveitis. Most patients were followed for several months (mean 11, range 4-21 months).
HZO can rarely cause an acute orbital syndrome and we present what may be the largest series of such patients to date. HZO can affect various orbital structures including the lacrimal gland, recti muscles, cranial nerves, and optic nerve sheath. A careful clinical examination and detailed orbital radiography are critical in proper diagnosis and treatment of such patients. The single patient in our cohort who received systemic steroids along with antivirals did not show a quicker resolution of orbital disease compared to the patients who did not receive glucocorticoids.
This PDF is available to Subscribers Only