What is the recommended initial management for herpes zoster ophthalmicus?

What is the recommended initial management for herpes zoster ophthalmicus?

• A. Refer to ophthalmology ASAP and initiate oral antiviral therapy
• B. Begin topical antibiotic therapy
• C. Delay treatment to monitor progression
• D. Use topical steroids alone

Answer: (A)

Herpes zoster ophthalmicus can quickly threaten vision because the varicella-zoster virus involves the eye and surrounding structures, leading to keratitis, uveitis, corneal ulcers, or optic nerve involvement. The most important action is to start systemic antiviral therapy promptly to limit viral replication and reduce the risk of ocular complications, ideally within 72 hours of onset. Because the eye requires specialized assessment and management, an urgent ophthalmology referral is essential to evaluate for corneal involvement, guide topical therapies, and monitor intraocular pressure or inflammation. Topical antibiotics alone don’t address the viral infection, and using steroids without antiviral coverage can allow the infection to progress, so the combination of early oral antiviral treatment with ophthalmology input is the best initial approach.

Herpes zoster ophthalmicus can quickly threaten vision because the varicella-zoster virus involves the eye and surrounding structures, leading to keratitis, uveitis, corneal ulcers, or optic nerve involvement. The most important action is to start systemic antiviral therapy promptly to limit viral replication and reduce the risk of ocular complications, ideally within 72 hours of onset. Because the eye requires specialized assessment and management, an urgent ophthalmology referral is essential to evaluate for corneal involvement, guide topical therapies, and monitor intraocular pressure or inflammation. Topical antibiotics alone don’t address the viral infection, and using steroids without antiviral coverage can allow the infection to progress, so the combination of early oral antiviral treatment with ophthalmology input is the best initial approach.