Title: What's the Diagnosis? Image by Dr. Thuy Pham

Category: Visual Diagnosis

Posted: 3/3/2014 by Haney Mallemat, MD

32 year-old male presents with the following. What's the diagnosis?

Answer: Hutchinson's Sign

Herpes zoster ophthalmicus (HZO)

HZO occurs when varicella-zoster, becomes reactivated in the ophthalmic division (V1) of the trigeminal nerve; any of the V1 branches may be affected (supraorbital, lacrimal, and nasociliary branches); nasocilliary innervates the globe.
Most patients develop only a periorbital rash, but a minority of patients have corneal involvement; the risk is increased in immunocompromised patients.
Hutchinson’s sign is when the rash occurs at the tip of the nose; patients with the sign have twice the incidence of ocular involvement, but 33% with HZO do not develop the sign.
Corneal involvement can result in significant visual complications and vision loss. Slit lamp exam with fluorescein is required when corneal involvement is suspected; a dendritic pattern may be seen.
Patients with eye involvement should be referred for urgent ophthalmologic evaluation following initiation of antiviral medications.

Follow me on Twitter (@criticalcarenow) or Google+ (+criticalcarenow)