Herpes Zoster Ophthalmicus (HZO)
What causes HZO?
This is caused by the Varicella Zoster Virus. This comes from a previous infection ie Chickenpox. It lies dormant in the body but can then reactivate. This is in the form of Herpes Zoster or ‘Shingles’. HZO is caused when the ophthalmic division of the Trigeminal nerve is affected.
What are the risk factors?
People who have low immune systems either naturally or from medication are at risk. HIV/AIDS is quite a common pre-disposing factor. Increasing age has a higher incidence.
What are the symptoms?
Pain, altered sensation and sometimes headache on the affected side. A feeling of being generally unwell and maybe a fever also.
What are the signs?
Red painful rash and vesicles on forehead and upper eyelid of the affected side. Lesion on the side of the tip of the nose – Hutchinsons’s Sign. Oedema around the eye. If the eyes are involved: A red eye can be present, due to Conjunctivitis, Episcleritis, Scleritis, Uveitis or Keratitis. Patients are also at a low risk to secondary Glaucoma.
How is it treated?
Normally anti-virals are prescribed to treat urgently. Px’s can have post-herpetic neuralgia which can last a considerable amount of time. Complications can still arise years later. So, the quicker the onset of treatment, the better. Rest, eating well and hydration are important also.
Advice if virus is active.
Stay away from older people, pregnant women and children who haven’t had chicken pox yet.
Reference: College of Optometrists Guidelines
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