Practice 10-Minute Consultation

Herpes zoster ophthalmicus

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2624 (Published 13 August 2009) Cite this as: BMJ 2009;339:b2624
  1. Fook Chang Lam, specialist registrar in ophthalmology1,
  2. Allison Law, general practitioner2,
  3. William Wykes, consultant ophthalmologist1
  1. 1Department of Ophthalmology, Southern General Hospital, Glasgow G51 4TF
  2. 2Southbank Surgery, 17-19 Southbank Road, Kirkintilloch G66 1NH
  1. Correspondence to: F C Lam fook_chang{at}hotmail.com
  • Accepted 19 March 2008

A 65 year old woman attends your practice with a two day history of a vesicular rash around her right eye. She also reports a general feeling of fatigue and malaise and has been slightly feverish over the past week. She had noticed a pain around her right eye even before the skin eruption began.

What issues you should cover

What is it and why has she got it?

After an attack of chickenpox the virus (varicella zoster) remains dormant in the body. This virus is kept in check by the immune system. However, in 20% of people the virus is reactivated, resulting in a localised painful rash with blisters (shingles). The commonest cause is a weakening of the immune system with age; most patients are aged over 50 years. Other causes include stress, fatigue, and a weakening of the immune system from other illnesses or from medical treatment (such as chemotherapy or immunosuppression).

When the eruption involves the area around the eye (the ophthalmic or first division of the trigeminal nerve), this is called herpes zoster ophthalmicus, irrespective of whether the actual eye itself is involved. Ophthalmic herpes zoster accounts for 10-25% of all cases of shingles.

Have I got the right diagnosis?

The main differential diagnosis is herpes simplex infection. In herpes simplex the patients are usually young, and the rash will not follow a dermatome, nor will …

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