Complete Third Nerve Palsy With Pupil Involvement in Herpes Zoster Ophthalmicus: A Case Report

Simultaneous complete oculomotor nerve palsy in herpes zoster ophthalmicus (HZO) is rare. We report a case of a 65-year-old lady who presented with a right drooping eyelid for 2 days associated with rashes over her right forehead. Examination showed crusted vesicular lesions on the right V1 dermatome with right complete ptosis, anisocoria, and limited right extraocular movement on all gazes except full movement on abduction. The anterior chamber showed mild right eye anterior chamber inflammation and bilateral fundus examinations were normal. Other neurological examinations were normal. Neuroimaging also was normal. A diagnosis of complete third nerve palsy secondary to HZO with keratouveitis was made. HZO-causing cranial nerve palsy is a relatively uncommon finding. In severe cases with significant nerve involvement, additional treatments or interventions may be necessary to manage the third nerve palsy and its associated complications.