Simultaneous Oculomotor and Trochlear Nerve Palsy in Herpes Zoster Ophthalmicus

Simultaneous oculomotor and trochlear nerve palsy in Herpes Zoster Ophthalmicus (HZO) is rare. We report a 78-year-old lady who presented with right ptosis while receiving treatment for HZO keratouveitis. Examination showed crusted vesicular lesions on the right V1 dermatome with right complete ptosis and limited right eye extraocular movement on adduction, supraduction, infraduction, and intorsion. There was mild right eye anterior chamber inflammation, while bilateral fundus examinations were normal. Other neurological and systemic examinations were unremarkable. Neuroimaging was also normal. Corticosteroids treatment was started, in addition to oral acyclovir, given for a total course of six weeks. Her ocular motor cranial neuropathy (OMCN) was partially resolved during the follow-up at one year. OMCN can be an isolated complication of HZO, or it may be associated with other neurological complications. Although recovery for OMCN is anticipated, the patient should be closely monitored for the possibility of developing other devastating neurological complications.