A 42-year-old immunocompetent man developed left-sided orbital and temporal stabbing pain, accompanied by ipsilateral lacrimation and conjunctival injection with periorbital edema (figure 1A). On day 10, Hutchinson sign, which is defined as zoster skin lesions in the root, dorsum, and apex of the nose,1 became evident with severe keratoconjunctivitis and iritis (figure 1B). PCR testing of blood revealed varicella-zoster virus and he was diagnosed with herpes zoster ophthalmicus (HZO). Hutchinson sign indicates the involvement of the nasociliary nerve, a branch of ophthalmic nerve innervating the eyelid, nose, and eye (figure 2), and is the strong predictor of the ocular complications of HZO.1,2 Compared to HZO in the absence of Hutchinson sign, the presence of Hutchinson sign indicates a 3.4-fold increase in the risk of developing ocular inflammation and a 4-fold increase in the risk of developing corneal denervation.2
Lacrimation and conjunctival injection in the left eye with periorbital edema were evident on day 7 (A). On day 10, zoster appeared in the root, dorsum, and apex of the nose, which is known as Hutchinson sign (B).
The dermatome of the nasociliary nerve is shown with the infratrochlear (red) and the external nasal (blue) nerve branches.
Study Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Disclosure
The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Appendix Authors
Footnotes
Go to Neurology.org/N for full disclosures.
Teaching slides links.lww.com/WNL/B295
- © 2020 American Academy of Neurology
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
