J Korean Ophthalmol Soc.  2016 Feb;57(2):341-345. 10.3341/jkos.2016.57.2.341.

Cases of Oculomotor Nerve Palsy in Herpes Zoster Ophthalmicus

• Lee YM
• Chang MH

• KMID: 2213679
• DOI: http://doi.org/10.3341/jkos.2016.57.2.341

Abstract

PURPOSE
To report two case of oculomotor palsy accompanied by herpes zoster ophthalmicus (HZO).
CASE SUMMARY
Two patients with HZO who were suffering from skin lesions, facial pain, and medicated with an antiviral agent from the dermatologic department, were diagnosed with oculomotor palsy. They presented with ptosis, dilated pupils, and ophthalmoplegia after 10 days, and 4 days after began developing skin lesions. They were diagnosed with HZO-induced oculomotor palsy and the ophthalmoplegia improved in all cases.
CONCLUSIONS
Oculomotor nerve palsy rarely occurrs in HZO patients and is usually followed by skin lesions. We recommend examinations for functions of extraocular motility, ptosis, and pupil to diagnose and treat the HZO-induced oculomotor nerve palsy even if consulted with the dermatologic department or only showing mild conjunctivitis, episcleritis, or keratitis.

Keyword

Herpes zoster ophthalmicus; Oculomotor nerve palsy; Ophthalmoplegia

MeSH Terms

Conjunctivitis
Facial Pain
Herpes Zoster Ophthalmicus*
Herpes Zoster*
Humans
Keratitis
Oculomotor Nerve Diseases*
Oculomotor Nerve*
Ophthalmoplegia
Paralysis
Pupil
Scleritis
Skin

Figure

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  Figure 1. Nine cardinal gaze positions of case 1. Limitation of adduction, elevation and depression were present in the right eye (the right eyelid was manually lifted due to ptosis).

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  Figure 2. Slit-lamp photographs of anisocoria. (A) Large ound pupil of the right eye. (B) Small round pupil of the left eye.

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  Figure 3. Nine cardinal gaze positions of case 2. Limitation of adduction and depression were present in the left eye.

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  Figure 4. Left eyelid ptosis and dilated pupil of left eye.

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  Figure 5. Fundus photographs in the left eye of case 2. The fundus photography shows the optic disc swelling in the left eye.

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