HERPES ZOSTER OPHTHALMICUS IN A CHILD

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Introduction. Herpes zoster ophthalmicus (HZO) is defined as the infection of herpes zoster virus of the ophthalmic division of the fifth cranial nerve. It generally affects older patients and is uncommonly seen in childhood. Case presentation. A 13 year old black female presented with pain and swelling of her left eyelid along with skin lesions on her left forehead for one week. She denied a past history of chickenpox. She was seen at the emergency room and prescribed tobramycin for conjunctivitis. Her best-corrected acuity was 20/25 OD, OS. External examination revealed vesicular lesions on the forehead and left upper lid respecting the midline. Biomicroscopy revealed 3+ conjunctival injection and NaFl staining in a pseudo-dendritic pattern on the cornea OS. There were trace cells in the anterior chamber at this visit. She was diagnosed with herpes zoster ophthalmicus and prescribed bacitracin ung for the skin lesions, topical prednisolone acetate 1% OS QID and co-managed with ophthalmology for oral antiviral treatment of acyclovir 5 times a day. She was referred to her pediatrician for a full systemic assessment. One week later, the corneal lesions had resolved, the skin lesions nearly healed, but her ocular inflammation persisted and she remained on topical prednisolone acetate 1%. She remained on topical medication for inflammation for over 2 months before a taper was successfully initiated without visual complications. The systemic evaluation is still pending. Deviation From the Expected. Herpes zoster is a rare finding in a child, particularly with no prior history of chickenpox. However, it does occur and may present with ophthalmic complications. Discussion. HZO rarely occurs in a child. The most commonly reported systemic conditions associated with the zoster virus occurring in a child are autoimmune disease, HIV infection and malignancy. Other risk factors include acquired intrauterine varicella infection or during the first year of life but may also occur in an otherwise healthy individual. Management is similar to adult herpes zoster and includes oral or intravenous antivirals as well as topical steroids and/or antivirals 76 for treatment of ocular manifestations. Fortunately, post herpetic neuralgia is not a common complication in children following zoster infection as in adults. Co-management with the pediatrician is important to rule out underlying systemic causes. Conclusion. Though herpes zoster is a rare finding in a child, it does occur and may present with ophthalmic complications. Grants. None