Abducens Palsy Associated with Herpes Zoster Opthalmicus: Case Report
DOI:
https://doi.org/10.12970/2310-998X.2021.09.02Keywords:
Abducens nerve, palsy, herpes zoster opthalmicus, ocular complications, varicella zoster virus.Abstract
The occurrence of ocular palsies in the course of herpes zoster opthalmicus (HZO) is a rare but severe complication. The oculomotorius nerve is most commonly involved, whereas there are only a few published cases reporting paralysis of the abducens nerve. We describe the case of a 55-year-old woman who developed a sixth nerve palsy a few days after appearance of a painful skin lesions on the right side of her forehead. Polymerase chain reaction (PCR) was positive for VZV. The patient was treated with intravenous acyclovir. 6 months after initial manifestation, the patient still had a partial palsy of the abducens nerve.
References
Anagnostou E, Mouka V, Kemanetzoglou E, Kararizou E. Fourth and sixth nerve palsies due to Herpes Simplex 1 infection. J Neuroophthalmol 2015; 35(1): 57-9. https://doi.org/10.1097/WNO.0000000000000184
Sanjay S, Huang P, Lavanya R. Herpes zoster ophthalmicus. Curr Treat Options Neurol 2011; 13(1): 79-91. https://doi.org/10.1007/s11940-010-0098-1
Pandey PK, Garg D, Bhatia A, Jain V. Horner's syndrome and sixth nerve palsy due to herpes zoster ophthalmicus arteritis. Eye (Lond) 2005; 19(2): 224-6. https://doi.org/10.1038/sj.eye.6701451
Liesegang TJ. Herpes zoster ophthalmicus natural history, risk factors, clinical presentation, and morbidity. Ophthalmology 2008; 115(2 Suppl): S3-12. https://doi.org/10.1016/j.ophtha.2007.10.009
Chaker N, Bouladi M, Chebil A, et al. Herpes zoster ophthalmicus associated with abducens palsy. J Neurosci Rural Pract 2014; 5(2): 180-2. https://doi.org/10.4103/0976-3147.131673
Shin MK, Choi CP, Lee MH. A case of herpes zoster with abducens palsy. J Korean Med Sci 2007; 22(5): 905-7. https://doi.org/10.3346/jkms.2007.22.5.905
Babu K, Kini R, Murthy KR. Unique presentation of 3rd and 6th cranial nerve palsies, nodular scleritis and nummular keratouveitis in an immunocompetent patient following an attack of herpes zoster ophthalmicus. Ocul Immunol Inflamm 2012; 20(5): 365-7. https://doi.org/10.3109/09273948.2012.701702
Tokoro S, Igawa K, Yokozeki H. Herpes zoster ophthalmicus with severe ocular complications. J Dermatol 2015; 42(12): 1207-8. https://doi.org/10.1111/1346-8138.13143
Shaikh S, Ta CN. Evaluation and management of herpes zoster ophthalmicus. Am Fam Physician 2002; 66(9): 1723-30.
Kim JY, Lee JH, Lee CS, Lee SC. Varicella zoster virus-associated Chorioretinitis: a case report. BMC Ophthalmol 2018; 18(1): 28. https://doi.org/10.1186/s12886-018-0696-3
Schünke M, Schulte E, Schumacher U. Prometheus. LernAtlas der Anatomie. Band 2, Kopf, Hals und Neuroanatomie. 1st ed. Stuttgart: Georg Thieme Verlag, 2015; pp. 122-123. https://doi.org/10.1055/b-0036-132016
Davis AR, Sheppard J. Herpes Zoster Ophthalmicus Review and Prevention. Eye Contact Lens 2019. https://doi.org/10.1097/ICL.0000000000000591