J Korean Ophthalmol Soc.  2008 Jun;49(6):1028-1032. 10.3341/jkos.2008.49.6.1028.

Two Cases of Optic Neuritis in Herpes Zoster Ophthalmicus

• Kim JY
• Ahn M
• Lee DW

• KMID: 2110888
• DOI: http://doi.org/10.3341/jkos.2008.49.6.1028

Abstract

PURPOSE: We report the treatment and prognosis of two patients who experienced pain in their face associated with skin lesions and acute decreased visual acuity and were diagnosed with optic neuritis caused by the herpes zoster virus.
CASE SUMMARY
Two patients were diagnosed with herpes zoster ophthalmicus after experiencing an acute decrease in visual acuity and were sent to our clinic for examination. On ophthalmic evaluation, the results were positive for relative afferent pupillary defect (RAPD) and showed abnormal VEP levels. On MRI T1, one case showed a high signal along the optic nerve sheath. Both patients with optic neuritis were treated with Acyclovir (Zovirax(R), GlaxoSmithKline, U.K.), which is an antiviral drug, at a dose of 10 mg/kg every 8 hours for 5 days, and a combination of prednisolone at a dose of 250 mg every 6 hours. After general therapy, they took Acyclovir (250 mg) orally 3 times daily for 14 days, with steroids (40 mg), and decreased the dosage after two weeks. We saw no improvement of visual acuity in either case, which still showed RAPD.
CONCLUSIONS
Optic neuritis secondary to herpes zoster ophthalmicus rarely occurs, but it is difficult to treat and has a poor prognosis. We should keep in mind that optic neuritis can occur in patients who were diagnosed with herpes zoster ophthalmicus.

Keyword

Herpes zoster ophthalmicus; Optic neuritis

MeSH Terms

Acyclovir
Herpes Zoster
Herpes Zoster Ophthalmicus
Herpesvirus 3, Human
Humans
Optic Nerve
Optic Neuritis
Prednisolone
Prognosis
Pupil Disorders
Skin
Steroids
Visual Acuity
Acyclovir
Prednisolone
Steroids

Figure

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  Figure 1. Skin eruptions corresponding to the dermatome of the left ophthalmic branch of the trigerminal nerve are seen.

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  Figure 2. VEP (visual evoked potential) study stimulating with LED-Goggle and recording from scalp showed absent evoked potential on the right side and acceptable valules on the left side.

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  Figure 3. Magnetic resonance imaging showed enlarged and well‐ enhanced right optic nerve sheath after contrast injection on T1 weighted sagittal image.

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  Figure 4. The blister formation and parasthesis on the right side of forehead was seen.

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  Figure 5. VEP (visual evoked potential) study. On the right side, the Latency of P2 was delayed and amplitude decreased. On the other side, the latency of P1, N1, P2 was delayed and amplitude decreased.

Reference

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