Welcome to Review of Optometry's Practice Pearl of the Week series. Optometrist Paul Karpecki will provide you invaluable clinical information and management strategies for a host of ocular conditions—from dry eye and corneal infection to retinal artery occlusion and neuro-ophthalmic disease.

Although most patients who present with herpes zoster ophthalmicus (HZO) are elderly, there are times when young patients manifest the condition. The cause is a reactivation of the varicella virus that originally presented as chicken pox at a younger age. Over time, the condition remains dormant in the dorsal root ganglion and then, for some reason, manifests in a dermatome later in life (or potentially earlier if a patient is immunocompromised).

In any case of suspected HZO, it is absolutely critical to determine if the patient is immunocompromised. So, it is important to ask younger patients who manifest symptoms of HZO if they have experienced general malaise, a low-grade fever, night-sweats, weight loss or other systemic symptoms.

One of the most common causes of HZO in a young patient is constant stress; however, this is a diagnosis of exclusion. Other causes of zoster in young patients include HIV, cancer, hepatitis or other serious contributors to an immune system compromise.

In summary, if a younger patient presents with suspected HZO, be sure to initiate oral antiviral therapy and treat any ocular signs, such as iritis, as well as consider a medical work-up by the internist to rule out an underlying cause.

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