HERPES-ZOSTER OPHTHALMICUS AS A CAUSE OF HORNER SYNDROME

Herpes zoster ophthalmicus is a disease in which the varicella-zoster virus replicates and produces inflammation in the skin of the face sup plied by the sensory branches of the ophthalmic division of the trigem inal nerve. It can also cause a conjunctivitis, keratitis, uveitis, ex traocular muscle paralysis, and acute retinal necrosis. We found only a single report of this disease as a cause of Horner syndrome. Here we report a case of herpes zoster ophthalmicus that progressed to a sixt h nerve palsy and, subsequently, a Horner syndrome. We discuss how the anatomic relationship of the fifth, sixth, and sympathetic nerves in the cavernous sinus provides a route whereby the varicella-zoster viru s may produce a Horner syndrome. To our knowledge this is the first fu lly documented case of Horner syndrome caused by herpes zoster ophthal micus.