Herpes Zoster Ophthalmicus

Differential diagnosis

Possible management by Optometrist

Treatment

PoM Early treatment with oral Aciclovir (within 72 hours after rash onset) reduces the risk of ocular involvement and lessens acute pain
Topical lubricants for relief of ocular symptoms
Refer to local Pharmacist for analgesia for pain relief (Paracetamol or Ibuprofen; dose depends on age)

Advice

Refer all patients to General Practitioner for a course of oral anti-viral therapy
Rest and general supportive measures (reassurance, support at home, good diet, plenty of fluids)
Advise avoidance of contact with
- Elderly or pregnant individuals
- Babies and children not previously exposed to varicella zoster virus (chicken pox)
- Immunodeficient/immunosuppressed patients
Stronger analgesics (e.g. opiates) may be indicated (co-manage with GP)
Review patient at one week to check for development of uveitis

Management Category

Emergency referral (same day) to GP for systemic anti-viral treatment
- Management to resolution if co-managed with GP and keratitis limited to epithelium
Urgent referral to ophthalmologist if
- Uveitis
- Scleritis
- Keratitis
- Retinitis

Possible management by Ophthalmologist