Herpes zoster ophthalmicus

Gasserian Ganglion and Retrobulbar Nerve Block in the Treatment of Ophthalmic Postherpetic Neuralgia: A Case Report

“…41,42 Although corticosteroids have a potent anti-inflammatory action, which may minimize nerve damage and prevent or relieve PHN, 22,23,43 it is also possible that topical application to the eye 44 and intraorbital and spinal subarachnoid injection may potentiate viral reactivation, allowing wider dissemination. 30,31 We did not observe wider systemic viral dissemination with our patient, probably due to the low dosage of steroid injected. Real-time fluoroscopy also allowed us to limit the volume of contrast agent injected into the restricted space of Meckel's cave and, at the same time, reduce the chance of inadvertent intravascular injection of lidocaine and contrast.…”

“…Although corticosteroids have a potent anti‐inflammatory action, which may minimize nerve damage and prevent or relieve PHN, it is also possible that topical application to the eye and intraorbital and spinal subarachnoid injection may potentiate viral reactivation, allowing wider dissemination . We did not observe wider systemic viral dissemination with our patient, probably due to the low dosage of steroid injected.…”

“…Reactivation of the VZV occurs when immunity is decreased due to the influence of certain risk factors, including increasing age . This can lead to acute hemorrhagic inflammation, neuronal damage, axonal degeneration, demyelination of sensory fibers, and distinct skin inflammatory changes in the corresponding dermatomes . A neuropathic pain state, termed PHN, can then develop, especially when no effective treatment is considered .…”

“…The inflammatory complications of reactivation of HZV were seen in our patient's forehead skin, cornea, and lacrimal glands. Involved structures in the orbit can also include extraocular muscles, the uvea, and neural structures of the eye …”

“…26 include extraocular muscles, the uvea, and neural structures of the eye. [7][8][9]31,36 We believe that peripheral neural lesions can play an important pathophysiological role in the development of acute and persistent pain following herpes zoster infection. 36 This mechanism may explain the development of residual oculodynia.…”