Picture Quiz #106
This 25-year-old person complained of a sore left eye associated with a history of left-sided facial pain and a skin rash affecting the forehead and eyelids over the last month
What is the likely diagnosis?
a. Eczema b. Herpes simplex virus infection c. Contact dermatitis d. Herpes zoster ophthalmicus e. Measles
What test should be advised?
a. Skin test for allergens b. Cell culture for herpes simplex virus c. Blood test for HIV
Which of the following are ocular complications of this condition?
a. Keratitis b. Iritis c. Cataract d. Anaesthetic cornea e. Raised intraocular pressure
1. d. Herpes zoster ophthalmicus (HZO).
2. c. Many patients with HZO have no obvious predisposing cause, but HIV is a risk factor, so the patient should be advised to have a test for HIV infection. HZO is usually more severe in HIV-positive patients.
3. a, b, d and e. Ocular complications are more likely if the nasociliary branch of the trigeminal nerve is involved, shown by a rash on the side of the nose. HZO may cause keratitis and/or iritis, often associated with raised IOP. An anaesthetic cornea leading to chronic corneal ulceration (neurotrophic keratitis) is a serious long-term complication. Lid scarring with deformities can also lead to exposure keratitis.