Abducens Nerve Palsy as a Rare Complication of Herpes Zoster Ophthalmicus: A Case Report

TL;DR

A 45-year-old healthy woman developed abducens nerve palsy from herpes zoster ophthalmicus, a rare complication typically seen in older or immunocompromised individuals.

Contribution

Reports a rare case of abducens nerve palsy in a young, healthy HZO patient with full recovery using standard treatment.

Findings

Abducens nerve palsy occurred in a 45-year-old woman with no comorbidities.

Standard antiviral and corticosteroid treatment led to full recovery of ocular function.

Case highlights the importance of recognizing atypical HZO complications for timely treatment.

Abstract

Herpes zoster ophthalmicus (HZO) is a condition resulting from the reactivation of dormant varicella zoster virus within the sensory nerve ganglion in the ophthalmic branch of the trigeminal nerve. The tell-tale rash along one side of the nerve tract accompanied by pain, a burning sensation, and itching alerts health practitioners on the right path to diagnosis. Conversely, HZO can present with other rarer complications such as intraocular and extraocular manifestations.

This case report deals with a seemingly healthy 45-year-old female who developed left abducens nerve palsy within one week of developing a vesicular rash on the same side. Curiously, those afflicted are usually of an advanced age or suffer from an immunocompromised state; this patient however suffered from no other comorbidities nor did she report having been in contact with anyone of a similar affliction. In this case, the classical treatment regime of antivirals and corticosteroids resulted in the complete resolution of the infection and the return of full ocular function. Being able to recognize and appreciate these typical and atypical signs and symptoms of HZO can aid in the further propagation of good outcomes and timely resolutions.

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