Cases of Oculomotor Nerve Palsy in Herpes Zoster Ophthalmicus

Yu Mi Lee; Moo Hwan Chang

doi:10.3341/jkos.2016.57.2.341

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Lee and Chang: Cases of Oculomotor Nerve Palsy in Herpes Zoster Ophthalmicus

Case Report

J Korean Ophthalmol Soc 2016;57(2):341-345.

Published online: 7 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.2.341

Cases of Oculomotor Nerve Palsy in Herpes Zoster Ophthalmicus

Yu Mi Lee, MD, Moo Hwan Chang, MD, PhD

Department of Ophthalmology, Dankook University Medical College, Cheonan, Korea

Address reprint requests to Moo Hwan Chang, MD, PhD Department of Ophthalmology, Dankook University Hospital, #201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea Tel: 82-41-550-6497, Fax: 82-41-561-0137 E-mail: changmh@dankook.ac.kr

Received 23 July 2015 Revised 3 September 2015 Accepted 11 November 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report two case of oculomotor palsy accompanied by herpes zoster ophthalmicus (HZO).

Case summary

Two patients with HZO who were suffering from skin lesions, facial pain, and medicated with an antiviral agent from the dermatologic department, were diagnosed with oculomotor palsy. They presented with ptosis, dilated pupils, and ophthalmoplegia after 10 days, and 4 days after began developing skin lesions. They were diagnosed with HZO-induced oculomotor palsy and the ophthalmoplegia improved in all cases.

Conclusions

Oculomotor nerve palsy rarely occurrs in HZO patients and is usually followed by skin lesions. We recommend examinations for functions of extraocular motility, ptosis, and pupil to diagnose and treat the HZO-induced oculomotor nerve palsy even if consulted with the dermatologic department or only showing mild conjunctivitis, episcleritis, or keratitis.

Keywords: Herpes zoster ophthalmicus, Oculomotor nerve palsy, Ophthalmoplegia

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Figure 1.

Nine cardinal gaze positions of case 1. Limitation of adduction, elevation and depression were present in the right eye (the right eyelid was manually lifted due to ptosis).

Figure 2.

Slit-lamp photographs of anisocoria. (A) Large ound pupil of the right eye. (B) Small round pupil of the left eye.

Figure 3.

Nine cardinal gaze positions of case 2. Limitation of adduction and depression were present in the left eye.

Figure 4.

Left eyelid ptosis and dilated pupil of left eye.

Figure 5.

Fundus photographs in the left eye of case 2. The fundus photography shows the optic disc swelling in the left eye.

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