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Case Reports
. 2019 Feb 6;10(1):61-66.
doi: 10.1159/000496683. eCollection 2019 Jan-Apr.

Maxillary Zoster and Neurotrophic Keratitis following Trigeminal Block

Yang Kyung Cho  1 , JinWoo Kwon  1 , Sangeetha Pugazhendhi  2 , Balamurali K Ambati  3
Affiliations
Case Reports

Maxillary Zoster and Neurotrophic Keratitis following Trigeminal Block

Yang Kyung Cho et al. Case Rep Ophthalmol. .

Abstract

Herpes zoster ophthalmicus is commonly used to describe viral reactivation from the trigeminal ganglia with ocular involvement. The ophthalmic branch is the most commonly involved, whereas the maxillary and mandibular dermatomes are less commonly affected. Neurotrophic ulcer may occur secondary to intentional or inadvertent damage to the trigeminal nucleus, root, ganglion, or any segment of the ophthalmic branch of this cranial nerve. We report a case of reactivated maxillary herpes zoster combined with neurotrophic keratitis due to percutaneous 2nd and 3rd branch of trigeminal nerve block with alcohol to treat trigeminal neuralgia. A 57-year-old female came to the ophthalmology department complaining of decreased visual acuity and skin vesicle over the right lower lid and cheek. She had undergone right trigeminal nerve block for treatment of trigeminal neuralgia. Clinical examination revealed neurotrophic keratitis and maxillary herpes zoster. She was treated with oral and topical antivirals and vigorous lubrication with eye drops. Her neurotrophic keratitis showed a slow recovery. Although a few cases of herpes zoster following nerve block have been described, it would appear that a case of simultaneous maxillary herpes zoster and neurotrophic keratitis following trigeminal block has not yet been documented. It is possible that trigeminal nerve block may cause reactivation of latent virus and refractory neurotrophic keratitis.

Keywords: Maxillary herpes zoster; Neurotrophic keratitis; Trigeminal nerve block.

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Figures

Fig. 1
Fig. 1
a Epithelial defect and Descemet's membrane folding. b Fluorescein staining of epithelial defect.
Fig. 2
Fig. 2
a Geographic epithelial defect and recurrent Descemet's membrane folding. b Geographic fluorescein staining of epithelial defect.
Fig. 3
Fig. 3
a Remaining central corneal opacity. b Specular microscopy of uninvolved left eye. c Specular microscopy of right eye. d Peripheral epithelial staining and linear epithelial irregularity. e Skin vesicle scar on right cheek.
See this image and copyright information in PMC

References

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