Differential Diagnosis for Facial Shingles around the Eye
- Single most likely diagnosis
- Herpes Zoster Ophthalmicus (HZO): This is the most likely diagnosis due to the presentation of shingles around the eye, which is a common manifestation of HZO. The varicella-zoster virus reactivates in the trigeminal nerve ganglion, leading to a painful rash in the distribution of the ophthalmic branch (V1) of the trigeminal nerve.
- Other Likely diagnoses
- Herpes Simplex Keratitis: Although less likely than HZO, herpes simplex keratitis can cause similar symptoms, including pain, redness, and a rash around the eye. However, it typically involves the cornea and is often accompanied by conjunctivitis.
- Contact Dermatitis: An allergic reaction or irritant contact dermatitis could cause a rash around the eye, but it would typically be less painful and not follow a specific dermatomal distribution.
- Eczema (Atopic Dermatitis): Eczema can cause a rash around the eye, but it is usually bilateral, itchy, and not confined to a specific dermatome.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Acute Angle-Closure Glaucoma: Although rare, acute angle-closure glaucoma is a medical emergency that can present with severe eye pain, redness, and blurred vision. It requires immediate treatment to prevent permanent vision loss.
- Orbital Cellulitis: This is a serious infection of the tissues surrounding the eye, which can cause pain, redness, and swelling. If left untreated, it can lead to serious complications, including vision loss and cavernous sinus thrombosis.
- Malignant Ophthalmic Tumors: Although rare, malignant tumors such as basal cell carcinoma or squamous cell carcinoma can cause a rash or lesion around the eye. Early detection and treatment are crucial to prevent serious consequences.
- Rare diagnoses
- Varicella (Chickenpox): Although rare in adults, varicella can cause a rash around the eye, but it is usually accompanied by a more widespread rash and systemic symptoms such as fever and malaise.
- Ramsay Hunt Syndrome Type 2: This is a rare condition caused by the reactivation of varicella-zoster virus in the geniculate ganglion, leading to a rash in the ear and facial weakness. Although rare, it can cause similar symptoms to HZO, including a rash around the eye.