Journal List > J Korean Soc Radiol > v.66(3) > 1087081

Oh, Cho, and Kim: Herpes Zoster Ophthalmicus Presenting as Acute Orbital Myositis Preceding a Skin Rash: A Case Report


Herpes zoster ophthalmicus, in which orbital symptoms and signs appear before the onset of a skin rash, is very rare. We experienced such a case and therefore report on it via magnetic resonance imaging. A 48-year-old man with pain and swelling of left eye and headache presented 2 days before onset of a zoster skin rash. On orbital MRI, edematous thickening of the left lateral rectus muscle with high signal intensity was revealed. After contrast injection, the lateral rectus muscle demonstrated heterogenous enhancement. Also, diffuse contrast enhancement was noted at left preseptal space, lacrimal gland and periorbital soft tissue. The man was treated with antiviral agents and prednisolone. Two weeks later, he recovered from the skin manifestations and most of the orbital manifestations except for the diplopia and restricted lateral movement.


1. Womack LW, Liesegang TJ. Complications of herpes zoster ophthalmicus. Arch Ophthalmol. 1983. 101:42–45.
2. Marsh RJ, Cooper M. Ophthalmic herpes zoster. Eye (Lond). 1993. 7:350–370.
3. Vardy SJ, Rose GE. Orbital disease in herpes zoster ophthalmicus. Eye (Lond). 1994. 8:577–579.
4. Shaikh S, Ta CN. Evaluation and management of herpes zoster ophthalmicus. Am Fam Physician. 2002. 66:1723–1730.
5. Volpe NJ, Shore JW. Orbital myositis associated with herpes zoster. Arch Ophthalmol. 1991. 109:471–472.
6. Kawasaki A, Borruat FX. An unusual presentation of herpes zoster ophthalmicus: orbital myositis preceding vesicular eruption. Am J Ophthalmol. 2003. 136:574–575.
7. Tseng YH. Acute orbital myositis heralding herpes zoster ophthalmicus: report of a case. Acta Neurol Taiwan. 2008. 17:47–49.
8. Badilla J, Dolman PJ. Orbital myositis involving the oblique muscles associated with herpes zoster ophthalmicus. Ophthal Plast Reconstr Surg. 2007. 23:411–413.
9. Yuen SJ, Rubin PA. Idiopathic orbital inflammation: distribution, clinical features, and treatment outcome. Arch Ophthalmol. 2003. 121:491–499.
10. Shin HM, Lew H, Yun YS. A case of complete ophthalmoplegia in herpes zoster ophthalmicus. Korean J Ophthalmol. 2005. 19:302–304.
Similar articles