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Herpes Zoster Ophthalmicus — SCE Dermatology MCQ

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ModerateCutaneous InfectionHerpes Zoster OphthalmicusSCE Dermatology

A 42-year-old woman presents with recurrent herpes zoster ophthalmicus (HZO). She has vesicles on the tip of her nose (Hutchinson sign). What does a positive Hutchinson sign indicate?

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Correct answer: B — Involvement of the nasociliary branch of the ophthalmic division — high risk of ocular complications

Hutchinson sign in herpes zoster ophthalmicus is the presence of vesicles on the tip or side of the nose, indicating involvement of the nasociliary branch of the ophthalmic division (V1) of the trigeminal nerve. This branch also innervates the eye (cornea, iris, ciliary body), so its involvement significantly increases the risk of ocular complications (keratitis, iritis, scleritis, secondary glaucoma). Patients with HZO, especially with a positive Hutchinson sign, require urgent ophthalmological assessment and systemic antiviral therapy (oral Valaciclovir or IV Aciclovir if immunocompromised). Approximately 50-72% of HZO patients with Hutchinson sign develop ocular disease.

Reference: BAD/BHIVA 2022 VZV Guidelines; RCOph