Unique Presentation of 3rd and 6th Cranial Nerve Palsies, Nodular Scleritis and Nummular Keratouveitis in an Immunocompetent Patient following an Attack of Herpes Zoster Ophthalmicus

Abstract

Aim: To report a unique presentation of 3rd and 6th cranial nerve palsies with nodular scleritis and nummular keratouveitis following an attack of herpes zoster ophthalmicus (HZO).

Methods: Case report.

Case Report and Results: A 56-year-old woman with a 1-month history of HZO presented with drooping of the right upper eyelid, diplopia, and pain around the right eye. She was noted to have right 3rd and 6th cranial nerve palsies. She developed nodular scleritis and nummular keratouveitis at 2 and 4 months follow-up, respectively, which were treated with antivirals and steroids. At 10 months follow-up, although the diplopia in right lateral gaze persisted, there was no recurrence of ocular inflammation with complete recovery of ptosis.

Conclusions: A unique presentation of multiple cranial nerve palsies with nodular scleritis and nummular keratouveitis in an immunocompetent patient following an attack of HZO is highlighted in this report.

KEYWORDS::

• 3rd cranial nerve palsy
• 6th cranial nerve palsy
• Herpes zoster ophthalmicus
• Keratouveitis
• Scleritis

Declaration of interest: The authors report no conflicts of interest.