A severe sight-threatening complication of herpes zoster ophthalmicus: Orbital Apex Syndrome.

Abstract

A 39-year old male patient presented with severe herpes zoster ophthalmicus (HZO) on the left side of his face and developed orbital apex syndrome (OAS) despite systemic valacyclovir therapy. Persistent low vision, ptosis, limitation of extraocular muscle movements, anisocoria, epiphora, and photophobia led to suspicion of OAS. OAS was confirmed by orbital MRI. Intravenous acyclovir and systemic corticosteroids were initiated. Gradual recovery occurred over six months. The patient was seronegative for HIV and syphilis. He reported alcohol consumption for the last few months. This case increased awareness of a rare, but a sight-threatening complication of HZO in an immunocompetent patient.

Orbital apex syndrome due to herpes zoster infection in a patient with chronic kidney disease: A case report

“…[8][9][10][11][12][13][14][15][16] Among the published cases of OAS, the average age of patients was approximately 67 (range 29-84) years. [8][9][10][11][12][13][14][15][16] Most affected patients were women (80%). [8][9][10][11][12][13][14][15][16] Our patient was male with an older age than previous reports.…”

“…The authors reviewed previous case reports describing OAS, which totaled 19 cases. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 Among the published cases of OAS, the average age of patients was approximately 67 (range 29–84) years. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 Most affected patients were women (80%).…”

“…Current evidence published in the literature suggests that OAS treatment is possible using antiviral plus anti‐inflammatory drugs via either an oral or intravenous route. However, a definitive treatment of this condition remains unclear 8–16 …”

“…In recent years, several cases OAS caused by herpes zoster infection have been more reported. 9 , 10 , 11 , 12 , 13 , 14 Regarding OAS, various clinical presentations, treatments, and long‐term sequelae can occur. Current evidence published in the literature suggests that OAS treatment is possible using antiviral plus anti‐inflammatory drugs via either an oral or intravenous route.…”

“…However, a definitive treatment of this condition remains unclear. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 …”