Herpes zoster ophthalmicus with contralateral hemiparesis. A case report and review of the literature.

An 80-year-old man developed right herpes zoster ophthalmicus complicated by contralateral hemiparesis after right cataract extraction. Although herpes zoster ophthalmicus is a frequent occurrence among the elderly, the association with contralateral hemiparesis is probably overlooked by many ophthalmologists. A review of the literature has been made to outline the etiology of this problem and to make diagnosis more likely. The varicella virus probably spreads in a retrograde fashion from the gasserian ganglion toward the cavernous sinus to involve cranial nerves 3, 4, or 6. Involvement of the ipsilateral carotid arterial system by the progressive inflammatory reaction can result in the contralateral hemiparesis. Standard therapy includes topical steroids and topical antibiotics for the ocular and surface lesions. The efficacy of systemic steroids to minimize the hemiparesis is still in question.