FP950 : Herpes Zoster Ophthalmicus (HZO) with Third nerve palsy: An unusual case in a pediatric patient

Dr.Vimal Krishna Rajput

HZO is a rare form of shingles that present with a rash in distribution of Vth nerve dermatomes. A 16 year old girl presented with the inability to open her left eye since 10 days. A week earlier she had developed rash on left side of her face and redness of left eye and was on oral and topical acyclovir.Left eye had 6/6 BCVA, complete ptosis, mid dilated pupil and absent corneal sensations. The scars on skin involved the tip of nose. Only abduction and intorsion was intact.Plain MRI brain and orbit and serological investigations were normal. MRA showed inflammation around the left oculomotor nerve and optic nerve sheath, in view of which oral steroids under cover of systemic antivirals was advised; but the patient opted against it.The ocular status remained the same till 3 months of follow up. Ophthalmoplegia is a rare complication of HZO & cases in literature describe it as relatively late sequalae and in elderly age group, unlike the acute presentation in a pediatric patient.