Orbital apex syndrome is a rare manifestation of
Herpes Zoster Ophthalmicus. Herein we report on a case of orbital apex syndrome secondary to
Herpes Zoster Ophthalmicus. A 75 year-old male complained of vision loss, conjunctival
hyperemia and
proptosis on the left eye, was referred to our clinic. Visual acuity was 5/10 Snellen lines and he had conjunctival
hyperemia, chemosis, minimal nuclear
cataract and
proptosis on the left eye. A diagnosis of
orbital pseudotumor was demonstrated firstly. The patient received oral and topical
corticosteroids, antiinflammatory and
antibiotic agents. On day 2, vesiculopustular lesions were observed,
Herpes Zoster Ophthalmicus was diagnosed and
corticosteroid treatment stopped, oral
acyclovir treatment initiated. Two days later, total
ophthalmoplegia, ptosis and significant visual loss were observed on the left. The diagnosis of orbital apex syndrome was considered and the patient commenced on an intravenous
acyclovir treatment. After the improvement of acute symptoms, a
tapering dose of oral
cortisone treatment initiated to accelarate the recovery of
ophthalmoplegia. At 5-month follow-up, ptosis and ocular motility showed improvement. VA did not significantly improve because of
cataract and
choroidal detachment on the left. We conclude that
ophthalmoplegia secondary to
Herpes Zoster Ophthalmicus responds favourably to intravenous
acyclovir and
steroids.