56-year-old man with a red, painful left eye and a rash on his left forehead
Cataract/Anterior Segment
What is your diagnosis?
The diagnosis is...
The image is consistent with a diagnosis of herpes zoster keratitis.
- Common symptoms include excessive tearing, a red and painful eye, photophobia, and decreased visual acuity.
- There are multiple corneal etiologies of a painful red eye.
- If left untreated, herpes zoster keratitis can recur, cause scarring, and lead to permanent vision loss.
What is the role of the primary care or emergency medicine physician?
This patient presenting with a painful, red eye accompanied by a rash should be started on the appropriate oral antiviral medications and urgently referred to an ophthalmologist.
What is the role of the ophthalmologist?
- Perform a slit-lamp examination, with the use of dyes to visualize any corneal abnormalities.
- Differentiate viral etiologies from each other, for example, herpes simplex keratitis (dendritic branching pattern) from herpes zoster keratitis (pseudodendritic pattern).
- Monitor for fluctuations in intraocular pressure, depth of corneal involvement, and signs of scar formation throughout treatment duration.
What is the treatment?
- Oral or intravenous (IV) antiviral treatment can be started within 72 hours of the appearance of the rash to reduce pain, limit ocular involvement, and promote recovery.
- Cool compresses, analgesics, and steroids can be added for additional pain relief.
- If blinking is impaired, a lubricating or antibiotic ointment may be indicated.
Learn more: Ophthalmology resources for medical students