Orbital apex syndrome secondary to herpes zoster ophthalmicus

Abstract

Herpes zoster ophthalmicus usually presents with ocular manifestations, but neurological complications are much more infrequent. An 84-year-old woman with herpes zoster of the left first trigeminal branch developed herpetic keratouveitis in her left eye despite treatment with oral valaciclovir. Seven days later, a progressive and total left ophthalmoplegia appeared, requiring hospital admission and intravenous treatment with acyclovir and corticosteroids. The neuroimaging was suggestive of an orbital apex syndrome. The evolution of the ophthalmoplegia was favourable, with complete resolution at 5 months, but with decreased visual acuity due to the optic nerve involvement.

Keywords: Herpes zoster ophthalmicus; Oftalmoplejía; Ophthalmoplegia; Orbital apex syndrome; Síndrome del ápex orbitario; Varicella zoster virus; Virus varicela zóster.