Osteopathic Manipulative Treatment of Herpes Zoster Ophthalmicus/Postherpetic Neuralgia

Abstract

Herpes zoster (HZ) and herpes zoster ophthalmicus (HZO) are the result of reactivation of varicella-zoster virus (VZV) from a dormant condition. Although HZ symptoms typically subside after a few weeks, HZO and postherpetic neuralgia (PHN) can persist at least 90 days after the appearance of the HZ rash. Presently, there is no gold standard for a disease-modifying therapy for postherpetic neuralgia and the current treatment is focused on early intervention and management of symptoms and dermatological complications. In the present case, a 74-year-old Caucasian male initially developed severe right-sided eye pain and headache. He was diagnosed with HZO and treated with acyclovir, but later developed swelling over the right eye and skin rash over the right side of the forehead and face. He presented to the office after the acute manifestation of the infection disappeared, but the headache and scalp hypersensitivity persisted and increased. Osteopathic manipulative treatment (OMT) included correction of cranial strains, inhibition, myofascial release, balanced ligamentous tension, and facilitated positional release. In one week, the patient reported a reduction in pain from 10/10 to 2/10. Two weeks later, he reported complete resolution of his initial symptoms. There are a limited number of cases that illustrate the benefit of OMT in diminishing pain and associated symptoms in different types of neuralgias. OMT ensures the restoration of normal anatomical structure and associated function through correcting somatic dysfunction, normalization of blood supply, muscle tone, and lymphatic drainage, therefore, providing pain relief. Better documentation of case reports and more research in this area would greatly benefit the medical community. The present case demonstrates the successful treatment of PHN with OMT. OMT can be successfully used as an adjunct therapy in cases of HZ and PHN.

Keywords: herpes zoster ophthalmicus; herpes zoster virus; osteopathic manipulative medicine; postherpetic neuralgia.

Figure 1. HZO presentation on the initial visit (pre-treatment).

(A) Edema and inflammation of the right upper eyelid (blepharitis); (B) conjunctivitis of the right eye; (C) skin rash involving the ophthalmic division of the trigeminal nerve on the right – presenting in a unilateral dermatomal distribution. HZO: herpes zoster ophthalmicus.

Figure 2. Complete resolution of patient’s symptoms 33 days after receiving osteopathic manipulative treatment.