A Case of Unilateral Trochlear Nerve Palsy with Herpetic Uveitis in Herpes Zoster Ophthalmicus

Lee, Jeffrey; Kim, Su Jin

Case Report

Annals of Optometry and Contact Lens 2016;15(4):154-156.
Published online December 25, 2016.

A Case of Unilateral Trochlear Nerve Palsy with Herpetic Uveitis in Herpes Zoster Ophthalmicus

Department of Ophthalmology, Maryknoll Medical Center¹, Busan, Korea
Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine², Changwon, Korea

Received: 15 June 2016 • Revised: 8 July 2016 • Accepted: 11 July 2016

Abstract

Purpose: To report a case of unilateral trochlear nerve palsy with herpetic uveitis in herpes zoster ophthalmicus.
Case summary: A 67-year-old man presented with binocular diplopia of 4 days duration. He has been diagnosed with herpes zoster ophthalmicus based on the vesicles on left forehead and periocular area with accompanying pain, and has been taken antiviral agents and steroid for 4 days. Anterior chamber reaction was seen in left eye on slit lamp examination and extorsion of left eye was seen on fundus examination. He was diagnosed with trochlear nerve palsy based on the limitation of infraduction in the adducted position in left eye, and hypertropia in left eye, which is, aggravated by adduction of left eye and head tilt to the left. He was treated with antiviral agents and steroid and complete resolution of ophthalmoplegia occurred after 2 months of treatment.
Conclusions: Unilateral trochlear nerve palsy with herpetic uveitis can occur in herpes zoster ophthalmicus and can be improved with antiviral agents and steroid.

Key Words: Herpes zoster ophthalmicus; Trochlear nerve palsy; Uveitis