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Herpes Zoster Ophthalmicus — SCE Neurology MCQ

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HardCNS InfectionsHerpes Zoster OphthalmicusSCE Neurology

A 70-year-old taking prednisolone and azathioprine develops a painful vesicular eruption over the left forehead and tip of the nose. The left eye is red and visual acuity is reduced. What is the most appropriate next step?

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Correct answer: E — Start systemic antiviral therapy and obtain same-day ophthalmic assessment

A V1 zoster eruption involving the nasal tip with a red eye and reduced vision suggests herpes zoster ophthalmicus with ocular involvement. Because the patient has visual change and is immunosuppressed, systemic antiviral therapy should start while same-day ophthalmic assessment identifies keratitis, uveitis or raised intraocular pressure. Waiting for PCR or a routine review delays treatment. Topical antiviral alone is inadequate, and unsupervised topical corticosteroid can worsen some ocular infections.

Reference: NHS, Shingles: https://www.nhs.uk/conditions/shingles/; Moorfields Eye Hospital, Ocular shingles: https://www.moorfields.nhs.uk/for-patients/information-hub/ocular-shingles