Orbital myositis with herpes zoster ophthalmicus

A 56-year-old man attended the emergency department with 2 days of right-sided frontal and supraorbital headache, with a dull throbbing and intermittent lancinating quality. He had photophobia but no phonophobia, nausea, vomiting or visual impairment. There was no diplopia but he did have discomfort on right lateral gaze. He was immunocompetent; his only relevant medical history was of familial hypercholesterolaemia requiring rosuvastatin. On examination, he was afebrile with normal vital signs and no rash. There was right-sided ptosis but pupils were equal and reactive. Visual acuity and fields were normal, and extraocular movements showed only slightly limited right eye abduction. The remaining neurological examination was normal.

We admitted him for pain control and investigations. CT scan of the head and CT cerebral angiogram were normal with no aneurysm or cavernous sinus thrombosis. Cerebrospinal fluid (CSF) showed normal glucose, protein and no cells. On the second day after admission, he developed right…

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