Herpes Zoster Ophthalmicus Complicated by Optic Neuritis: Diagnostic and Therapeutic Challenges

Herpes zoster ophthalmicus (HZO) is caused by reactivation of the varicella-zoster virus (VZV) in the ophthalmic branch of the trigeminal nerve and can result in a range of ocular complications. One of the rare but serious sequelae of HZO is optic neuritis, which can lead to significant visual impairment within a few days without timely management. We present a case of an immunocompetent adolescent female who developed right-sided retrobulbar optic neuritis following an episode of HZO. Her condition was confirmed with magnetic resonance imaging (MRI), which showed optic nerve involvement. Management included intravenous and oral antivirals, along with high-dose corticosteroids, resulting in partial visual recovery. This case underscores the need for heightened clinical suspicion for optic neuritis in patients presenting with HZO, even among young immunocompetent individuals. Prompt and aggressive antiviral and anti-inflammatory treatment, coupled with multidisciplinary management, is crucial for optimal visual outcomes.