Herpes zoster ophthalmicus is a serious eye infection caused by reactivation of the varicella zoster virus, which also causes chickenpox. It causes small blisters around the eyes, severe eye and eyelid pain, redness, swelling, and light sensitivity. It occurs when the virus establishes latency in sensory ganglia after a childhood chickenpox infection, and reactivates due to reduced immunity. Management involves antiviral medications like acyclovir, famciclovir, or valacyclovir to reduce symptoms and risk of complications affecting the eyelid, conjunctiva, cornea, retina, optic nerve, and rarely the brain.

2. INTRODUCTION
• IT IS A SERIOUS,VISION-THREATENING INFECTION THAT AFFECTS THE EYE AND SKIN SURROUNDING THE EYE.
• CAUSED BY REACTIVATION OF VARICELLA-ZOSTER VIRUS ,THE SAME VIRUS WHICH CAUSES CHICKENPOX IN CHILDREN.
• IT IS NOT TO BE CONFUSED WITH HERPES SIMPLEX VIRUS THAT CAUSES EYE HERPES.

3. SYMPTOMS
• 1.SMALL BLISTERS AROUND EYES.
• 2.SEVERE PAIN IN AND AROUND THE EYE.
• 3.EYE REDNESS.
• 4.SWELLING OF EYELID.
• 5. LIGHT SENSITIVITY.

4. HERPES ZOSTER
OPTHALMICUS SEEN
AFTER STANDING USING
COBALT BLUE LIGHT.

5. CHANGES IN SKIN
• VIRAL PRODROME
• PRE-HERPETIC NEURALGIA.
• RASH , TRANSITION FROM FROM PAPERLESS TO VESICLES TO PUSTULES TO SCABS.
• HUTCHINSON’S SIGN:CUTANEOUS INVOLVEMENT OF TIP OF NOSE , INDICATING NASOCILIARY NERVE INVOLVEMENT.

7. PATHOGENESIS
• IN TEMPERATE CLIMATES INFECTION OCCURS BEFORE THE AGE OF 10, MANIFESTS AS CHICKENPOX.
• VIRUS THEN ESTABLISHES THE LATENT STATE N SENSORY GANGLIA.
• WHEN THERE IS DIMINISHED VIRUS SPECIFIC AND CELL MEDIATED IMMUNITY , THE VIRUS MAY REACTIVATE AND
SPREAD TO THE CORRESPONDING DERMATOME ALONG A SPINAL OR CRANIAL NERVE TO GENERATE THE
CHARACTERISTIC UNILATERAL VESICULAR EXANTHEMA.

8. SEQUENCE

10. CHICKENPOX

11. • BEGINS WITH A PRODROME OF INFLUENZA LIKE ILLNESS-FATIGUE , MALAISE , NAUSEA AND MILD FEVER ACCOMPANIED
BY PROGRESSIVE PAIN AND SKIN HYPERESTHETIA.
• A DIFFUSE ERYTHEMA TO US OR MACULA-PAPULAR RASH THAN APPEARS OVER A SINGLE DERMATOME 3-5 DAYS LATER.
• THESE ERUPTIONS PROGRESS TO FORM CLUSTERS OF PAPULES AND CLEAR VESICLES, WHICH THEN EVOLVE THROUGH.
STAGES OF POSTULATION AND CRUSTING.

12. CLINICAL MANIFESTATIONS
• STRUCTURES INVOLVED ACUTE COMPLICATIONS CHRONIC COMPLICATIONS
• EYELID. RASH AND VESICLES. SCARRING , LOSS OF LASHES.
• CONJUNCTIVA. CONJUNCTIVITIS.
• CORNEA CORNEAL ULCERS. CORNEAL INFLAMMATION AND SCARRING
• RETINA. RETINITIS
• OPTIC NERVE OPTIC NEURITIS. GLAUCOMA
• ORBIT AND BRAIN. PARTIAL , COMPLETE PARALYSIS OF EYE MOVEMENTS

19. MANAGEMENT
• ACYCLOVIR ( 800MG , 5X A DAY)
• FAMCICLOVIR (500 MG TID FOR 7 DAYS)
• VALACYCLOVIR ( 1000MG TID)