#opthal See: [Dunn - Varicella zoster infections](x-devonthink-item://AA8BD512-6155-4307-A3F5-D5B7DB15D620) [eye and ear - Herpes Zoster Ophthalmicus](x-devonthink-item://448E3739-3890-4F46-AAEC-927CA7690430) > Ocular involvement in HZO is significantly increased if rash involves the tip of the nose (**Hutchinson’s sign**). means nasociliary branch involved, and this innervates the globe, ∴ ↑ risk # syndromes ## Ramsey Hunt syndrome > - pain > - vesicular eruptions > - vestibulocochlear dysfunction > - Facial nerve paralysis - Caused by *reactivation of herpes zoster in geniculate ganglion*. Subsequent spread to [[Cranial nerve palsies|CN VII]] - ==A triad of ipsilateral facial paralysis, ear pain, and vesicles on the face, on the ear, or in the ear is the typical presentation.== Review for Herpes Zoster Ophthalmicus (HZO) (no steroids for HZO) **Tx** - valaciclovir 1000mg TDS - aciclovir 400mg 5x/day preferred in pregnancy - pred 50mg/day x 10 days > [!quote] > The major **otologic complication of VZV reactivation** is the Ramsay Hunt syndrome, which typically includes the **triad** of ipsilateral **facial paralysis**, **ear pain**, and **vesicles in the auditory canal** or on the auricle . > > Ipsilateral *altered taste* perception and tongue lesions, *hearing abnormalities* (decreased hearing, tinnitus, hyperacusis (↑ sensitivity to sound) ), and lacrimation occur in some patients; vestibular disturbances (*vertigo*) are also frequently reported > > ***Treatment:*** > the treatment of Ramsey-Hunt syndrome is similar to that of Bell’s palsy; however, antiviral treatment (acyclovir 400 mg five times daily or **valacyclovir 1000 mg TDS**) is recommended.  > > [[Bell's Palsy]] steroids: 10-day course of oral corticosteroids with at least 5 days of high dose (**prednisolone 50 mg** for 10 days or prednisone 60 mg for 5 days with a 5-day taper). > > Both prednisone and antiviral therapy should be continued for 7 to 10 days ### Note on steroid taper (uptodate “glucocorticoid withdrawal") Per uptodate: “*Short-term glucocorticoid therapy* (two weeks or less) *can simply be stopped and need not be tapered*. Hypothalamic-pituitary-adrenal axis (HPA) suppression due to glucocorticoid use of this duration is unlikely, but can occur” See lancet 2000 “Suppression and recovery of adrenal response after short-term, high-dose glucocorticoid treatment.” Henzen C ## herpes zoster ophthalmicus > Ocular involvement in HZO is significantly increased if rash involves the tip of the nose (**Hutchinson’s sign**). - ​sight threatening lesion - ​periorbital zoster should receive oral antivirals - ​reduce complication rate - ​reduce acute pain  - ​review by ophthalmologist within 24 hours **Treatment** - aciclovir 800 mg orally 5 times a day for one week, or - ​famcilcovir 250 mg orally 8 hourly for one week, or - ​valaciclovir 1 g orally 8 hourly for one week ​may supplement with topical acyclovir ​IV aciclovir if site threatened **Ocular complications** - blepharitis - conjunctivitis - uveitis - episcleritis and scleritis - keratitis - retinal necrosis - blindness - orbital cellulitis **non-occular complications** - post-herpetic neuralgia - [[Cranial nerve palsies]] - secondary facial cellulitis - [[#Ramsey Hunt syndrome]] ![[Pasted image 20241109003107.png]] # Zoster in pregnancy - varicella infection during first trimester confers a small risk of miscarriage - maternal infection <20 weeks rarely result in foetal varicella zoster syndrome ; highest risk (2%) 13-20 weeks - clinical manifestations include growth retardation, cutaneous scarring, limb hypoplasia, and cortical atrophy of brain - intrauterine infection can result in herpes zoster in infancy. higher risk if infection late in pregnancy - maternal varicella may precipitate onset of premature labour - susceptible pregnant women whohave been exposed during pregnancy should seek specialist advice - may be offered zoster immune globulin (VZIG) and antivirals - if chickenpox develops in pregnancy, early medical review within 24 hours of rash onset is indicated to consider treatment options # OSCE - [RMH 2023 station 5](x-devonthink-item://CD88A366-3F67-4E84-9B24-E49A3E1E4AE1)