Severe Herpes Zoster Ophthalmicus Occurring after Acute Ischemic Stroke in an Elderly Patient: A Case Report

Abstract

Introduction: Herpes zoster ophthalmicus (HZO) results from reactivation of the varicella-zoster virus involving the ophthalmic division of the trigeminal nerve. It is an ophthalmic emergency because of the risk of severe ocular complications, particularly in elderly patients with multiple comorbidities. Case Presentation: We report the case of an 85-year-old man with poorly controlled diabetes mellitus and hypertension who was hospitalised for an acute ischaemic stroke. During hospitalisation, he developed severe left-sided HZO characterised by extensive necrotic periocular skin lesions, marked eyelid oedema, dendritic keratitis, and preseptal cellulitis. The diagnosis was established based on clinical and ophthalmological findings. The patient received intravenous acyclovir, systemic and topical antibiotics, local wound care, and surgical debridement of necrotic tissue. After a 10-day hospital stay, he was followed up on day 5 and day 20 after discharge, showing complete healing of the cutaneous lesions and resolution of keratitis. The final best-corrected visual acuity was 1/10, while postherpetic neuralgia persisted. Discussion: Advanced age, poorly controlled diabetes mellitus, and the temporal occurrence of HZO after acute ischaemic stroke may have contributed to increased susceptibility to varicella-zoster virus reactivation. However, this single case does not establish a causal relationship between ischaemic stroke and HZO. Early recognition and multidisciplinary management are essential to minimise ocular and infectious complications. Conclusion: This case highlights the potential severity of HZO in frail elderly patients and emphasises the importance of prompt diagnosis, multidisciplinary management, and close ophthalmological follow-up to optimise clinical outcomes.