In herpes zoster ophthalmicus, which sign indicates high risk of corneal involvement and urgent ophthalmology evaluation?

In herpes zoster ophthalmicus, which sign indicates high risk of corneal involvement and urgent ophthalmology evaluation?

• A. Hutchinson's sign
• B. Eyelid swelling
• C. Conjunctival injection
• D. Visual acuity unaffected

Answer: (D)

In herpes zoster ophthalmicus, involvement of the nasociliary nerve drives ocular complications. Hutchinson's sign—vesicles on the tip of the nose—signals nasociliary nerve involvement and markedly increases the risk of corneal involvement, keratitis, and other eye complications, so urgent ophthalmology evaluation is needed. Eyelid swelling and conjunctival injection are common inflammatory signs but do not specifically indicate a high risk of corneal disease. Visual acuity being normal does not rule out early corneal involvement, so the presence of Hutchinson's sign is the best red flag.

In herpes zoster ophthalmicus, involvement of the nasociliary nerve drives ocular complications. Hutchinson's sign—vesicles on the tip of the nose—signals nasociliary nerve involvement and markedly increases the risk of corneal involvement, keratitis, and other eye complications, so urgent ophthalmology evaluation is needed. Eyelid swelling and conjunctival injection are common inflammatory signs but do not specifically indicate a high risk of corneal disease. Visual acuity being normal does not rule out early corneal involvement, so the presence of Hutchinson's sign is the best red flag.