Orbital and Cavernous Sinus Involvement by Herpes Zoster Ophthalmicus

A single case of the effects of herpes zoster is demonstrated using external photographs and MRI imaging. The effects demonstrated include the typical dermatomal rash as well as extraocular muscle invovlement and cavernous sinus involvement. Figure 1 : External photograph of dermatomal rash and scar in left V1 distribution, left upper lid ptosis. Figure 2 : Motility photographs showing ptosis, limited abduction, elevation, and depression of the left eye leading to diplopia, suggestive of left third and sixth nerve palsies with possible orbital myositis Figure 3 : Axial T2 fat suppressed MRI image demonstrating relative hyperintense signal and thickening of the left extraocular muscles Figure 4 : Axial T1 post contrast fat suppressed MRI image demonstrating left medial rectus muscle, orbital apex, and left cavernous sinus enhancement Figure 5 : Coronal T1 post contrast fat suppressed MRI image through the cavernous sinuses demonstrating enhancement of the left cavernous sinus.