|Year : 1976 | Volume
| Issue : 3 | Page : 36-37
Trigeminofacial herpeszoster-a case report
Prof of Ophthalmology, Madras Medical College, Madras, India
Prof of Ophthalmology, Madras Medical College, Madras
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Anandakannan K. Trigeminofacial herpeszoster-a case report. Indian J Ophthalmol 1976;24:36-7
A case of Herpeszoster involving the gasserian as well as the geniculate ganglion is presented.
| Case History|| |
Mr. M. 45 years was admitted in Ophthalmic hospital with the complaints of pain over the left side of the face of 2 months duration and inability to close the eye for the past one month and loss of vision of fifteen days duration.
He developed vesicles over the left side of the face spreading from the forehead down to the cheak following intense pain over the face and in the ear two months ago. One month later he noted inability to close the left eye and drooping of the mouth on the left side. Subsequently he noticed loss of vision in that eye. No previous attack of chicken-pox.
On examination, vesicles were seen spread over the left side of the face from the forehead down to the cheak; [Figure - 1] Vesicles were seen over the pinna and external auditory meatus. [Figure - 2] There was slight diminution of hearing.
Lagophthalmos of the left eye with paralytic ectropion of lower lid was present. [Figure - 3] There was corneal ulcer with perforation; anterior chamber was flat and tension was low. There was defective, projection of light.
There was lower motor neuron type of facial palsy. No evidence of Hansen's disease was seen. Due to the distribution of the vesicles over the first and second division of the fifth nerve and the presence of facial palsy, the diagnosis of Trigeminal facial herpeszoster was made..
A complete tarsorraphy was done on admission which did not take tip successfully. Subsequently conunctival hooding by Gundersen's flap technique was done which helped in retaining the globe but the vision remained the same as on admission.
Right eye was normal.
| Discussion|| |
Involvement of the ophthalmic division of the Trigeminal Nerve is the commonest manifestation of the Herpeszoster. Affections of the other divisions of the fifth nerve are rare. Involvement of the Geniculate ganglion (Romsay Hunt Syndrome) is usually isolated. But in this case there is composite involvement of the ophthalmic and maxillary divisions of the fifth nerve with associated Ramsay Hunt Syndrome.
Involvement of the geniculate ganglion produces herpetic vesicles preceeded by local pain in external auditory meatus and adjacent parts of pinna and on the soft palate and anterior pillar of fauces. Facial palsy develops after some days. Spread to chorda tympani will induce loss of taste over the anterior twothird of the tongue. Jnvolvemnt of the nerve to stapedius produces a hearing defect especially for high tones. There may also be auditory nerve involvement of ganglion of corti and scarpa leading to tinnitus, deafness, vertigo, nystagmus etc. These syndromes constiute the Romsay Hunt syndrome.
Trigeminofacial zoster is the involvement of the fifth and seventh nerves in the course of the disease. 125 cases have been recorded in the literature. Most authors feel that there is a double lesion of the two adjacent ganglion i. e. gasserian and geniculate are involved. Acres believes that the anatomical propinquity of the fifth and seventh nerves renders possible the understanding of some of the more obscure types of Ophthalmic Zoster. The sensory root of the facial nerve is formed by intermediary nerve of Wrisberg which enters the geniculate ganglion. A small collection of the sensory fibres from the chorda tympani nerve which along with the lingual nerve, a branch of trigeminal, shares the sensory innervation of the anterior part of the tongue. These anatomical connections may explain the dual involvement of the two cranial nerves.
| Summary|| |
A case of Trigminofacial herpes zoster is presented herewith for its rarity.
| Acknowledgement|| |
I wish to thank Dr. C. P. Gupta, F.R.C.S., D. O. (Lond.) for his guidance under whom the the patient was admitted, and Dr. N.S. Venugopal, M.S., D.O., Superintendent, Government Ophthalmic Hospital Madras for permitting me to publish the case.
| References|| |
Arnold Sorsby, 1972. Modern Ophtholmology 2 ndsub
Edition, 180, Butterworths, London,
Prince's, Text Book of the Practice of Medicine 10 th
sub edition, The English Lauguage Book Society and Oxford University Press, 1966, and 998.
Duke Elder, S., System of Ophthalmology 8
Port 1, Page 341, London, Henry Kimpton, 1965.
Tom E. Acres, 1964, Arch of Ophthal., 71,
[Figure - 1], [Figure - 2], [Figure - 3]