Paresis of cranial nerves 3, 4 and 6 associated with herpes zoster ophthalmicus: a case report

Abstract

Cranial nerve 3, 4, and 6 paresis is an uncommon complication of herpes zoster ophthalmicus (HZO) as opposed to isolated ocular motor neuropathies which may present following cutaneous HZO. When the ocular motor nerves are affected in isolation, the third nerve is most commonly involved, followed by the sixth and fourth cranial nerves. Complete ophthalmoplegia occurs most often in patients over the age of 50 and usually presents within 1–2 weeks of the development of cutaneous HZO. The prognosis for recovery is good with complete or near complete resolution within 18 months. A review of the clinical features of HZO and its pathogenesis will be discussed.