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Unilateral complete ophthalmoplegia: rare complication of herpes zoster ophthalmicus

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Session Details

Session Title: Presented Poster Session: Infection & Imaging

Venue: Poster Village: Pod 2

First Author: : W.Zhang UK

Co Author(s): :                           

Abstract Details

Purpose:

Herpes zoster ophthalmicus (HZO) characteristically present with vesicular rash affecting the ophthalmic dermatome of the trigeminal nerve following varicella zoster reactivation. Ocular complications affect approximately 50% of cases, typically resulting in; keratitis, iritis, muscular palsies or optic neuritis. A rare case of unilateral complete ophthalmoplegia affecting Cranial Nerves (CN) III, IV and VI (20 previous cases documented between 1948 – 2008) is discussed below.

Setting:

Royal Free NHS Trusts, London.

Methods:

A 91-year-old lady was admitted with neck of femur fracture with history of ischaemic heart disease and bilateral pseudophakia. 8 days following admission she reported left eye pain and gritty sensation. On examination: bilateral blepharitis, right eye visual acuity 6/12, left eye 6/9 with normal colour vision and fundus. Two days later, she developed CN V1 dermatome vesicular rash, Hutchinson positive, left eye counting fingers, Ishihara 8/17. Further examination: left eye pre-septal orbital cellulitis, ptosis, fixed dilated pupil, insensate cornea, total paralysis of cranial nerves III, IV and VI, CT head - optic nerve thickening consistent with optic neuritis.

Results:

Treatment with antibiotics for orbital cellulitis, 3-month course of prednisolone and acyclovir improved vision to 6/24 with full colour restoration and complete recovery of CN VI, limited improvement to CN III and IV – left eye remained ptotic, mildly abducted with dilated pupil.

Conclusions:

Due to the rare aetiology of unilateral complete ophthalmoplegia, it is vital to exclude other more common organic causes such as intracranial space occupying lesions, infarction, aneurysmal compression, thyroid eye disease, trauma and orbital pathology, hence the need for comprehensive further imaging studies such as CT/ MRI head.

Financial Disclosure:

None

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