# Multiple ocular manifestations in a patient diagnosed with herpes zoster ophthalmicus: case report

## TL;DR

A 70-year-old man developed multiple eye issues from herpes zoster ophthalmicus, showing the varied effects of the virus on the eye.

## Contribution

This case report highlights multiple sequential ocular complications in a single patient with herpes zoster ophthalmicus.

## Key findings

- The patient developed acute conjunctivitis, peripheral corneal infiltrates, episcleritis, and hypertensive anterior uveitis.
- Despite treatment, final visual acuity in the left eye remained unchanged.
- The case emphasizes the importance of monitoring and managing ocular complications in herpes zoster ophthalmicus.

## Abstract

Objective: Our purpose was to present a case of a patient diagnosed with herpes zoster ophthalmicus with multiple ocular manifestations.

Case presentation: A 70-year-old Caucasian male presented to the hospital for headache and skin hyperesthesia on the scalp and forehead on the left side. The diagnoses of herpes zoster ophthalmicus and acute conjunctivitis were made for the left eye. The patient was followed up for 6 months and during that period the following diagnoses were made for the same eye: peripheral sterile corneal infiltrates, episcleritis, and hypertensive anterior uveitis.

Discussions: Herpes zoster ophthalmicus occurs when the reactivation of the dormant virus involves the ophthalmic division of the trigeminal nerve. The most frequent ocular presentations are conjunctivitis, keratitis, uveitis, episcleritis, and scleritis. The standard therapy consists of antivirals, such as acyclovir, valacyclovir, and famciclovir to limit the replication of the virus. The patient’s risk factors, the course of treatment, and the severity of the disease, all affect the prognosis, which is highly variable. Prevention of the disease consists of vaccination with one of the following two vaccines, Zostavax and Shingrix.

Conclusions: Final visual acuity for the left eye remained 1 despite numerous manifestations of the disease.

Abbreviations: VZV = Varicella-zoster virus, BCVA = best-corrected visual acuity, OU = both eyes, OD = right eye, OS = left eye, IOP = intraocular pressure, NCT = non-contact tonometer, ZVX = Zostavax vaccine