title: Acute Orbital Syndrome in Herpes Zoster Ophthalmicus: Clinical Features of 7 Cases.
abstract: OBJECTIVE
  To report a series of patients with herpes zoster ophthalmicus and associated acute orbital syndrome with corresponding radiographic findings.
  
  
  METHODS
  Medical records of 7 patients with herpes zoster ophthalmicus with acute orbital findings were reviewed. Clinical presentation, radiography, and treatment outcomes were assessed.
  
  
  RESULTS
  One man and 6 women with a median age of 70 years (range 47-84) presented with herpes zoster ophthalmicus with acute clinical orbital signs. Two of the 7 patients had compromised immune systems, with 1 patient having chronic lymphocytic leukemia and another infected with human immunodeficiency virus. Clinical orbital findings included proptosis, blepharoptosis, ophthalmoplegia, diplopia, and visual loss. Orbital imaging detailed such findings as myositis in all 7 patients, dacryoadenitis in 2 patients, and optic nerve sheath enhancement in 1 patient. Treatment with intravenous acyclovir was universal in all 7 patients and in 2 cases systemic corticosteroids were also administered. Orbital signs improved in all patients over several months.
  
  
  CONCLUSIONS
  Herpes zoster ophthalmicus can rarely cause an acute orbital syndrome and the authors present what may be the largest series of such patients to date. Herpes zoster ophthalmicus can affect various orbital structures including the lacrimal gland, extraocular muscles, cranial nerves and optic nerve sheath. A careful clinical examination and detailed orbital radiography are critical in proper diagnosis and treatment of such patients. Improvement of symptoms and signs with antiviral therapy can be expected; however, complete resolution does not always occur. The role of systemic steroids in treatment of orbital disease is yet to be determined.
authors.affiliation: *Ophthalmology, SUNY Downstate Medical Center, Brooklyn, New York, †Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, ‡Ophthalmology, Jules Stein Eye Institute, Los Angeles, California, and §Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinic, Iowa City, Iowa, U.S.A.
authors.forename: Jenny
authors.initials: J
authors.lastname: Temnogorod
authors.forename: Renelle
authors.initials: R
authors.lastname: Pointdujour-Lim
authors.forename: Ronald
authors.initials: R
authors.lastname: Mancini
authors.forename: Shu-Hong
authors.initials: SH
authors.lastname: Chang
authors.forename: Richard C
authors.initials: RC
authors.lastname: Allen
authors.forename: Roman
authors.initials: R
authors.lastname: Shinder
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001763:Blepharoptosis / Q000175:diagnosis / Q000209:etiology*; D001766:Blindness / Q000175:diagnosis / Q000209:etiology*; D004172:Diplopia / Q000175:diagnosis / Q000209:etiology*; D005094:Exophthalmos / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006563:Herpes Zoster Ophthalmicus / Q000150:complications*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009886:Ophthalmoplegia; D013577:Syndrome; D014057:Tomography, X-Ray Computed