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Isolated, complete paralytic mydriasis secondary to herpes zoster ophthalmicus
  1. Craig N Czyz1,2,
  2. Thomas S Bacon3,
  3. Thomas P Petrie1,
  4. Joshua D Justice1,
  5. Kenneth V Cahill2
  1. 1Division of Ophthalmology, Section Oculofacial Plastic and Reconstructive Surgery, Ohio University/OhioHealth Doctor's Hospital, Columbus, Ohio, USA
  2. 2Department of Ophthalmology, Oral and Maxillofacial Surgery, Grant Medical Center, Columbus, Ohio, USA
  3. 3Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
  1. Correspondence to Dr Craig N Czyz, Division of Ophthalmology, Section Oculofacial Plastic and Reconstructive Surgery, Ohio University/OhioHealth Doctor's Hospital, 1100 Oregon Ave, Columbus, OH 43201, USA; dsp4000{at}aol.com

Abstract

Herpes zoster ophthalmicus is a manifestation of herpes zoster when the ophthalmic division of the trigeminal nerve becomes involved. Ocular symptoms are varied and mainly due to inflammatory mechanisms. Total, external and/or internal ophthalmoplegias, as well as isolated third, fourth and sixth cranial nerve palsies have all been reported as complications. In a minority of cases, concurrent pupillary paralysis has been documented. The presentation of complete paralytic mydriasis as the sole cranial nerve complication following herpes zoster ophthalmicus infection is a rare finding. The postulated pathophysiologic aetiology is a partial third nerve palsy with the pupillary fibres for light and accommodation-convergence affected and motor fibres spared. The mechanism responsible for the postulated lesion is speculative.

  • HERPES ZOSTER
  • PUPILS
  • OPHTHALMOLOGY

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