Herpes Zoster Ophthalmicus with Isolated Paralytic Mydriasis

Casal IA, Monteiro S, Borges T, Vale C, Friande A, Araújo M and Beirão JM

Centro Hospitalar do Porto – Hospital de Santo António, Portugal
Instituto de Ciências Biomédicas Abel Salazar, Universidade Porto, Portugal

^*Correspondance to: Inês Casal 

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Abstract:

Introduction: Herpes zoster ophthalmicus occurs when there is a reactivation of herpes 3 lying latent in the ophthalmic division of the trigeminal nerve. We report a case of an 86 year-old female patient with an orbital cellulitis with post-septal involvement admitted in our departement for topical and intravenous antibiotics. On the fourth day of admission vesicular lesions began to emerge in the left side of the face and scalp not exceeding the mid line and treatment for herpes zoster withoral acyclovir and topic ganciclovir was initiated. Then an anisocoria was noticed and in the left pupil the direct and consensual reflexes were abolished as well as the accommodation reflex. There was no intraocular hypertension, anterioror posterior synechiae; no external ophthalmoplegia, ptosisor diplopia. The brain CT revealed no relevant alterations. The patient was discharged after eighteen days of hospitalization, maintaining the paralytic mydriasis of the left pupil.Discussion: Isolated paralytic mydriasis as the only complication after herpes zoster ophthalmicusis extremely rare. The responsible mechanisms are notfully understood. It is thought that the cause is, among other factors, the involvement of the pupillary fibers for light and accommodationconvergence, with no damage of the motor fibers.

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Cite the Article:

Casal IA, Monteiro S, Borges T, Vale C, Friande A, Ara�jo M, et al. Herpes Zoster Ophthalmicus with Isolated Paralytic Mydriasis. Ann Clin Case Rep. 2016; 1: 1082.