Treatment of Herpes Zoster Ophthalmicus — First Branch of the Trigeminal Nerve
Clinical Scenario
This protocol addresses herpes zoster ophthalmicus — reactivation involving the first (ophthalmic) branch of the trigeminal nerve. It specifically applies when the skin supplied by the nasociliary nerve is affected, clinically indicated by Hutchinson's sign. Ophthalmological referral to exclude ocular involvement is an immediate priority.
Key Findings in This Presentation
- Herpes zoster ophthalmicus (first branch of the trigeminal nerve)
- Nasociliary nerve distribution involvement (Hutchinson's sign)
- Risk of ocular complications: keratitis, conjunctivitis, uveitis
Treatment Approach (Partial Overview)
Management centres on immediate intravenous antiviral therapy combined with topical ocular antiviral application; in select presentations with anterior segment involvement, additional topical treatment under close ophthalmological supervision is part of the approach.
Clinical Goals
- Resolution of ocular inflammation
- Prevention of ocular involvement (keratitis, conjunctivitis, uveitis)
References
DOI: 10.1111/ddg.14013
- All patients with herpes zoster ophthalmicus/herpes zoster of the first branch of the trigeminal nerve should be immediately started on acyclovir IV (8–10 mg/kg for 7–10 days) and referred to an ophthalmologist to rule out ocular involvement.
- For herpes zoster ophthalmicus, it is recommended to supplement systemic treatment with five-times daily application of topical acyclovir preparations (for example, acyclovir 3 % eye ointment) to the affected eye.
- For herpes zoster ophthalmicus with disciform keratitis, endotheliitis, or anterior uveitis, additional application of topical corticosteroids – under close supervision by an ophthalmologist – is recommended.