Multiple Cranial Nerve Palsies in Herpes Zoster Ophthalmicus – Rare Case Report and Review of Literature

Abstract

Herpes zoster ophthalmicus (HZO) is known to cause a variety of ophthalmic manifestations, of which cranial nerve palsies are rare. They are transient, self-resolving and late complications of the disease in the elderly. A 70 year old female with zosteriform rash on right hemi-face presented with headache and ocular complications of HZO. On examination, limited abduction of right eye, mild ptosis and anisocoria were noted. A diagnosis of HZO complicated by multiple cranial nerve involvement and post-herpetic neuralgia was made and managed with favorable outcome. This case highlights the importance of HZO as a cause of cranial nerve palsies in the elderly and a high index of suspicion is required for its management and long-term follow-up.