Shingles Strikes With a Vengeance

4. A 58-year-old man seeks care for burning in his right eye and a skin eruption on his forehead and scalp with progressive worsening over the past 10 days. The patient has decreased vision in his right eye, as well as fever, chills, photophobia, and headache. A physical exam reveals vesicles on an erythematous base on his right scalp, forehead, upper and lower eyelids, dorsum of his nose, and cheek distributed along the ophthalmic branch of the trigeminal nerve.

^{Photo courtesy of Orlando Veterans Affairs Medical Center}

Diagnosis: Herpes zoster ophthalmicus, confirmed by an ophthalmologic exam. This serious condition has been linked to reactivation of the varicella-zoster virus (VZV) within the trigeminal ganglion. Primary infection with VZV results in varicella (chickenpox), whereas reactivation of a latent VZV infection within the sensory ganglia is known as herpes zoster.

For more information, see “Painful rash on face.” J Fam Pract. 2015;64(11):E1-E3.

RELATED ARTICLE
Jacobsen E, Hull CE. “Herpes Zoster Infection.” Clinician Reviews. 2013;23(8):42-49.