bubble_chart Overview

Herpes zoster of the eyelid typically presents with clustered vesicular eruptions in the skin distribution areas of the first branch of the trigeminal nerve—the ophthalmic nerve (including the frontal, lacrimal, and nasociliary nerves)—or, less commonly, the branches of the third main division. These lesions do not cross the central midline of the eyelid and nose, remaining confined to one side.

bubble_chart Etiology

It is caused by acute viral infection of the trigeminal ganglion or one of its main branches. However, the mechanism of its invasion is not yet fully understood, and it often occurs in elderly individuals with weak constitutions. It can be divided into recurrent and primary types, with the former being relatively rare.

Herpes zoster is classified into epidemic (viral) and symptomatic types based on disease cause. The former may be caused by infection with the chickenpox virus type. The latter is symptomatic herpes zoster. In reality, it is merely a latent condition from a previous grade I infection that becomes active due to new inducing stimuli, with no essential difference from the epidemic type, except that the latter is more common in young people and prone to recurrence.

bubble_chart Clinical Manifestations

1. Before the onset of the disease, there are varying degrees of prodromal symptoms, such as shivering, nausea, vomiting, and general discomfort. After a few days, severe neuralgia appears in the affected area, accompanied by symptoms such as photophobia, tearing, and skin redness and swelling.

2. Clusters of transparent small blisters form on the eyelid skin, arranged in a带状 pattern. These later become cloudy and develop into pustules, which may rupture and erode, eventually drying and forming scabs. The general course of the disease lasts about two weeks. After the scabs fall off, superficial scars with pigmentation remain. In some cases, the herpes may suppurate, forming deep ulcers, accompanied by swelling of the corresponding lymph nodes, leaving permanent scars after healing. This can often be used to determine a history of the disease. Sometimes, bleeding may occur around the herpes, or tarsitis may develop in the deep layers of the eyelid.

3. Clustered带状 herpes on the eyelid skin depends on the affected area of the first branch of the trigeminal nerve. It generally appears in the distribution area of the first branch (ophthalmic nerve) of the trigeminal nerve, covering the forehead and upper eyelid. Sometimes, the second branch may be affected, in which case the lesions distribute on the lower eyelid, facial skin, and upper lip, never crossing the midline of the forehead to invade the other side. The third branch is rarely affected, and simultaneous involvement of all three main branches is even rarer. Neuralgia may persist for 1–2 months, sometimes lasting for months or even years before disappearing, leaving behind hypoesthesia and numbness after recovery.

4. If herpes appears on the nasal side or ala, it indicates involvement of the nasociliary nerve, which may lead to potential complications such as corneal, iris, scleral, uveal, optic nerve, and retinal involvement, as well as ocular muscle paralysis.

Corneal involvement may result in reduced vision, stromal opacity, or even ulcer formation. If the iris is affected, secondary glaucoma may occur even without pupillary seclusion, though this is uncommon.

bubble_chart Diagnosis

1. Unilateral herpes zoster appears in clusters within the distribution area of the first and/or second branch of the trigeminal nerve, not crossing the midline of the face.

2. Before the appearance of herpes, symptoms such as photophobia, lacrimation, severe pain along the nerve distribution, local skin redness and swelling, and general malaise may occur.

3. The herpes vary in size and are arranged in a band-like pattern. Initially colorless and transparent, they later become turbid and purulent, forming scabs that fall off after about 2 weeks, leaving scars or pigmentation.

4. Complications often include conjunctivitis, keratitis, iridocyclitis, and occasionally ocular muscle paralysis. {|103|}

bubble_chart Treatment Measures

1. Sooner or later, the use of antiviral drugs, such as high-concentration (35–40%) idoxuridine, dimethyl sulfoxide cotton pads for local application, used continuously for 3–4 days, can shorten the course of the disease and reduce sequelae. Apply 1% cytarabine ointment topically or administer cytarabine intravenously, with the first-day dose at 3mg per kilogram of body weight, followed by 2mg per kilogram every three days, along with vitamin B₁ and vitamin B₁₂. Ribavirin (virazole) is a broad-spectrum antiviral drug, which can be applied locally as a 0.5% solution or combined with oral administration of 100mg three times daily for good results. Recently, oral levamisole, 50mg three times daily, or 2–3% peanut oil drops applied to the affected area have also been used.

2. For concurrent keratitis or iridocyclitis, use 1% atropine solution to dilate the pupils to prevent posterior synechiae.

3. Oral prednisone, 50–60mg daily, taken once, with the dose reduced after pain relief.

4. For severe pain, compound aspirin, painkillers, and indomethacin can be taken, which have certain efficacy.

5. Enhance the body’s resistance: intramuscular injection of placental globulin or gamma globulin and interferon to prevent ocular complications and shorten the treatment course, or use convalescent-stage serum or blood injections.

6. Chinese medicinals

⑴ Intramuscular injection of Isatis Root, once daily, 4ml each time.

⑵ Modified Gentian Liver-Draining Decoction: Gentian 6g, Akebia Stem 6g, Plantain Seed 6g, Chinese Angelica 6g, Bupleurum 6g, Skullcap Root 9g, Cape Jasmine Fruit 9g, Unprocessed Rehmannia Root 9g, Indigowoad Root 9g, Daqingye 9g, Liquorice Root 3g. For severe pain, add raw oyster shell and magnetite, 30g each, decocted with water and taken daily as one dose.

⑶ Dyers Woad or Isatis Root 30g, decocted with water and consumed as tea.

6. For skin erythema, papules, and blisters, apply antipruritic calamine lotion. For ruptured blisters, use 1% Chinese Gentian Violet solution or tincture, avoiding contact with the eyes.

7. For intractable pain, irradiate the semilunar ganglion with X-rays.