RT Book, Section
A1 Mayeaux, Jr., E.J.
A1 Usatine, Richard P.
A2 Usatine, Richard P.
A2 Smith, Mindy A.
A2 Mayeaux, Jr., E.J.
A2 Chumley, Heidi S.
SR Print(0)
ID 1164353822
T1 Zoster Ophthalmicus
T2 The Color Atlas and Synopsis of Family Medicine, 3e
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 9781259862045
LK dermatology.mhmedical.com/content.aspx?aid=1164353822
RD 2022/08/17
AB A  44-year-old  HIV-positive  Hispanic  man  presented  with  painful  herpes  zoster  of  his  right  forehead  (Figure  131-1).  He  was  particularly  worried  because  his  right  eye  was  red,  painful,  and  very  sensitive  to  light  (Figure  131-2).  On  physical  examination,  there  was  significant  conjunctival  injection,  corneal  punctate  epithelial  erosions,  and  clouding,  and  a  small  layer  of  blood  in  the  anterior  chamber  (hyphema).  The  pupil  was  somewhat  irregular.  Along  with  the  hyphema  and  ciliary  flush,  this  indicated  an  anterior  uveitis.  The  patient  had  a  unilateral  ptosis  on  the  right  side  with  limitations  in  elevation,  depression,  and  adduction  of  the  eye  secondary  to  cranial  nerve  III  palsy  from  the  zoster.  The  patient  was  immediately  referred  to  ophthalmology  and  the  anterior  uveitis,  corneal  involvement,  and  cranial  nerve  III  palsy  were  confirmed.  The  ophthalmologist  started  the  patient  on  topical  ophthalmic  preparations  of  erythromycin,  moxifloxacin,  prednisolone,  and  atropine.  Oral  acyclovir  was  also  prescribed.  Unfortunately,  the  patient  did  not  return  for  follow-up  until  6  months  later,  when  he  returned  to  the  ophthalmologist  with  significant  corneal  scarring  (Figure  131-3).  The  patient  is  currently  on  a  waiting  list  for  a  corneal  transplantation.