Acute Orbital Syndrome in Herpes Zoster Ophthalmicus: Clinical Features of 7 Cases

Jenny Temnogorod, Renelle Pointdujour-Lim, Ronald Mancini, Shu Hong Chang, Richard C. Allen, Roman Shinder

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

PURPOSE:: To report a series of patients with herpes zoster ophthalmicus and associated acute orbital syndrome with corresponding radiographic findings. METHODS:: Medical records of 7 patients with herpes zoster ophthalmicus with acute orbital findings were reviewed. Clinical presentation, radiography, and treatment outcomes were assessed. RESULTS:: One man and 6 women with a median age of 70 years (range 47–84) presented with herpes zoster ophthalmicus with acute clinical orbital signs. Two of the 7 patients had compromised immune systems, with 1 patient having chronic lymphocytic leukemia and another infected with human immunodeficiency virus. Clinical orbital findings included proptosis, blepharoptosis, ophthalmoplegia, diplopia, and visual loss. Orbital imaging detailed such findings as myositis in all 7 patients, dacryoadenitis in 2 patients, and optic nerve sheath enhancement in 1 patient. Treatment with intravenous acyclovir was universal in all 7 patients and in 2 cases systemic corticosteroids were also administered. Orbital signs improved in all patients over several months. CONCLUSIONS:: Herpes zoster ophthalmicus can rarely cause an acute orbital syndrome and the authors present what may be the largest series of such patients to date. Herpes zoster ophthalmicus can affect various orbital structures including the lacrimal gland, extraocular muscles, cranial nerves and optic nerve sheath. A careful clinical examination and detailed orbital radiography are critical in proper diagnosis and treatment of such patients. Improvement of symptoms and signs with antiviral therapy can be expected; however, complete resolution does not always occur. The role of systemic steroids in treatment of orbital disease is yet to be determined.

Original languageEnglish (US)
JournalOphthalmic Plastic and Reconstructive Surgery
DOIs
StateAccepted/In press - Apr 4 2016

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Herpes Zoster Ophthalmicus
Optic Nerve
Radiography
Oculomotor Muscles
Orbital Diseases
Dacryocystitis
Blepharoptosis
Ophthalmoplegia
Lacrimal Apparatus
Myositis
Exophthalmos
Diplopia
Acyclovir
Cranial Nerves
B-Cell Chronic Lymphocytic Leukemia
Therapeutics
Signs and Symptoms
Medical Records
Antiviral Agents
Immune System

ASJC Scopus subject areas

  • Ophthalmology
  • Surgery

Cite this

Acute Orbital Syndrome in Herpes Zoster Ophthalmicus : Clinical Features of 7 Cases. / Temnogorod, Jenny; Pointdujour-Lim, Renelle; Mancini, Ronald; Chang, Shu Hong; Allen, Richard C.; Shinder, Roman.

In: Ophthalmic Plastic and Reconstructive Surgery, 04.04.2016.

Research output: Contribution to journalArticle

Temnogorod, Jenny ; Pointdujour-Lim, Renelle ; Mancini, Ronald ; Chang, Shu Hong ; Allen, Richard C. ; Shinder, Roman. / Acute Orbital Syndrome in Herpes Zoster Ophthalmicus : Clinical Features of 7 Cases. In: Ophthalmic Plastic and Reconstructive Surgery. 2016.
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