What to Do When VZV Affects the Reina, Optic Nerve, and Makes the Patient See Double?

VZV is an exclusive human neurotropic alpha herpes virus, which produces chicken pox. Greater than 95% human population demonstrates serological evidence of VZV infection before adolescence. Primary infection results in a lifelong period of latency in the neurons of the cranial, dorsal root, autonomic and enteric ganglia (1). VZV reactivation due to waning cell (T-cell) mediated immunity with advancing age or immunocompromised condition, results in replication of the virus in the ganglia followed by transaxonal spread to the mucocutaneous surfaces where it produces zoster (shingles) in the corresponding dermatome (2). Mucocutaneous zoster is characterized by a painful vesicular dermatomal rash, which in most patients resolves within 4-6 weeks. Approximately 1 million new episodes of zoster are estimated to occur annually in the US with a lifetime risk of 30%. The incidence of zoster across different populations is approximately 4-4.5 per 1000 person-years and appears to be increasing (3).