Visual Case Discussion

Herpes zoster ophthalmicus: The importance of face mask removal examination under the COVID-19 pandemic

Visual case discussion

A 47-year-old lady with Type 1 diabetes mellitus suffered from right forehead and periocular painful skin rash for 2 days. There was no trauma or injury, but her diabetic control was fair only with Hemoglobin A1c of 8.3% but normal renal function tests. Under the COVID-19 pandemic, she worn a face mask upon emergency department attendance, covering up the lower face. Physical examinations showed stable vital signs, and normal body temperature of 37.1 °C. There was obvious right face rash (Fig. 1

Multiple choice questions

Q1. What of the following is a possible ophthalmic manifestation of herpes zoster ophthalmicus (HZO)?

• 1)

  Dislocated lens

• 2)

  Keratitis

• 3)

  Orbital myositis

• 4)

  Rhegmatogenous retinal detachment

• 5)

  Trichiasis

Answer: (2) Keratitis

Ophthalmic manifestations of HZO include follicular conjunctivitis, uveitis, keratitis, episcleritis, scleritis, cranial nerve palsy or even acute retinal necrosis. Other choices of ocular signs are not related directly to HZO.

Q2. Which branch of the trigeminal nerve is more often affected by