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M. C. Ralstin, V. A. Purvin; Ophthalmoplegia Associated With Herpes Zoster Ophthalmicus: A Case Series. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5475.
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Ophthalmoplegia in HZO may be due to cranial nerve involvement (at the orbital apex or cavernous sinus) or orbital myositis. This is a rare condition and incompletely characterized. Our case series of 8 patients is the largest reported in the last 30 years.
A retrospective review was performed of 8 patients who presented with ocular motility deficits and HZO between 2000 and 2009. Presenting characteristics, imaging, and clinical course are reviewed. Follow-up ranged from a single visit to 26 months.
All patients had characteristic cutaneous zoster lesions. Mean onset of ophthalmoplegia after rash was 2 weeks (range -0.5 to 3.5), with one patient reporting onset of ophthalmoplegia 4 days before the rash appeared. 2 patients had possible orbital myositis, all other patients had CNIII involvement. CNIV and CNVI involvement occurred less commonly. 3 patients had associated optic neuropathy. Concurrent iritis was common, occurring in 7 of 8 patients. MRI demonstrated orbital or cavernous sinus inflammation in 4 patients, but was unremarkable in 4 patients. 6 of 8 patients were treated with both systemic corticosteroid and a systemic antiviral agent. Of the other 2 patients, 1 was treated with corticosteroid alone and the other with famciclovir alone. In the 6 patients with sufficient follow-up, complete resolution was observed in 5, with one patient demonstrating persistent ocular motility deficits and optic neuropathy.
HZO can cause ophthalmoplegia and optic neuropathy. Iritis was common in the setting of ophthalmoplegia. MRI, while sometimes helpful, was unremarkable in half of the patients. The prognosis for recovery is excellent.
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