Adem GÜL, Serek TEKİN, Erbil SEVEN, Tekin YAŞAR

A Herpes zoster ophthalmicus case with partial nerve paralysis of the oculomotor

A 48 years old Caucasian male patient admitted to our clinic with left side blepharoptosis and left periorbital itching complaints. In physical examination, patient’s left upper eyelid was totally ptotic and there was ulcerated periorbital skin lesions in the same side as well. There was a restriction with upward gaze in the left eye. Best corrected visual acuity was 20/100. There was fine keratic precipitates on the central and inferior area of the left endothelium and 3+ reaction in the anterior chamber. Patient was accepted with a diagnosis of herpes zoster ophthalmicus. Treatment was started in our department. Inflammation in the anterior chamber was completely resolved in the second week of treatment and visual acuity was 20/20 in left eye. In the fourth month of patient’s visit, blepharoptosis was resolved but limitation of the upward gaze was not resolved in the examination. According to our knowledge, this case may be the first herpetic involvement of superior divison of the oculomotor nerve in the aspect of clinical signs and may add contribution to the literature.

Keywords:

Herpes zoster, Oculomotor nerve, Oculomotor paralysis, Ptosis,

PDF

___

Chern, K. C., Margolis, T.P., 1998. Varicella zoster virus ocular disease. Int. Ophthalmol Clin. 38, 149-160.
Fujiwara, M., Odashiro, M., Mizoguchi, H., Hayashi, I., Kawamura, J., Hashimoto, T., Tamura, K. A., 1990. Case of herpes zoster ophthalmicus with complete ophthalmoplegia. Masui. 39, 248-252.
Im, M., Kim, B.J., Seo Y.J., Park J.K., Lee J.H., 2007. Complete ophthalmoplegia after herpes zoster. Clin. Exp. Dermatol. 32, 162-164.
Iwao, K, Kobayashi, H., Okinami S., 2006. Case of herpes zoster ophthalmicus with abducent palsy: The cause and magnetic resonance imaging findings. Nippon Ganka Gakkai Zasshi. 110, 193-198.
Nigam, P., Kumar, A., Kapoor, K.K., Sarkari, N.B., Gupta, A.K., Lal B.B., Mukhija R.D., 1991. Clinical profile of herpes zoster ophthalmicus. J. Indian Med. Assoc. 89, 117-119.
Schoenlaub, P., Grange, F., Nasica, X., Guillaume, J.C., 1997. Oculomotor nerve paralysis with complete ptosis in herpes zoster ophthalmicus: 2 cases. Ann. Dermatol. Venereol. 124, 401-403.
Shin, H.M., Lew, H., Yun, Y.S., 2005. A case of complete ophthalmoplegia in herpes zoster ophthalmicus. Korean J. Ophthalmol. 19, 302-304. Yanoff, M., Duker, J. S., 2008. Ophthalmology 3 rd edition. Edinburgh: Mosby. pp. 1303.