Ophthalmology Department; Centro Hospitalar Universitário De Lisboa Central, Lisbon.
Neurology Department, Hospital CUF Descobertas, Lisbon.
Strabismus. 2021 Sep;29(3):168-173. doi: 10.1080/09273972.2021.1948073. Epub 2021 Jul 9.
Varicella Zoster Virus (VZV) is a neurotropic virus whose reactivation can affect the central nervous system (CNS) and manifest as different neurological syndromes usually with dermatological involvement. Extraocular muscle palsies are not commonly described associated with VZV and their presence in the absence of a typical zoster rash is even rarer.
Case report of a young immunocompetent patient with unilateral abducens nerve palsy, as an isolated manifestation of VZV infection.
A 25-year-old healthy female presented to the emergency department with a subacute onset of painless horizontal binocular diploplia, over a month. Ophthalmological and neurological examination revealed an isolated right abducens nerve palsy, and polymerase chain reaction of the cerebrospinal fluid identified a VZV infection. There was no skin rash involvement. Other infectious, inflammatory, and autoimmune diseases were excluded. Treatment with intravenous acyclovir and dexamethasone improved but not completely resolved the diplopia and strabismus. The patient was submitted to a medial rectus recession surgery.
VZV manifestations in the CNS can occur in healthy young individuals and can manifest in the absence of the typical skin rash. Isolated sixth nerve palsy is a very rare manifestation of VZV infection. Young patients with isolated ocular motor mononeuropathies, even with cardiovascular risk factors, benefit from a CNS-based approach and MRI and lumbar puncture should be considered. Reports show that extraocular muscle palsy associated with VZV is a transient condition and resolve partially or completely after few weeks.
水痘带状疱疹病毒（VZV）是一种嗜神经病毒，其复发可影响中枢神经系统（CNS）并表现为不同的神经系统综合征，通常伴有皮肤受累。眼外肌麻痹并不常见于 VZV 相关疾病，且在没有典型带状疱疹皮疹的情况下更为罕见。
报告一例年轻免疫功能正常患者出现单侧展神经麻痹，为 VZV 感染的孤立表现。
一名 25 岁健康女性因无痛性双眼水平复视亚急性起病 1 个月就诊于急诊科。眼科和神经科检查发现右侧展神经麻痹，脑脊液聚合酶链反应（PCR）检测到 VZV 感染。无皮肤疹累及。排除其他感染、炎症和自身免疫性疾病。静脉用阿昔洛韦和地塞米松治疗后复视和斜视有所改善，但未完全缓解。患者接受了内直肌后退手术。
VZV 对 CNS 的影响可发生在健康的年轻个体，且可能无典型皮疹。孤立性第六脑神经麻痹是 VZV 感染的罕见表现。年轻患者出现孤立性眼运动单神经病，即使存在心血管危险因素，也应采用基于 CNS 的方法，且应考虑 MRI 和腰椎穿刺。有报道称，与 VZV 相关的眼外肌麻痹是一种短暂的情况，数周后可部分或完全缓解。
