Can Ramsay Hunt syndrome (Ramsay Hunt syndrome) affect the eyes and is it an ophthalmologist emergency?

From the Guidelines

Ramsey Hunt syndrome is not directly an ophthalmologic emergency, but it can lead to ocular complications that require urgent care, particularly if facial paralysis affects eyelid closure, potentially causing exposure keratitis. The syndrome is caused by the reactivation of the varicella-zoster virus in the facial nerve, as discussed in the management of suspected viral encephalitis in adults 1. While the primary issue is not with the eyes, the potential for ocular complications, such as exposure keratitis due to improper eyelid closure, necessitates careful eye protection and monitoring. Treatment for Ramsey Hunt syndrome typically involves antiviral medications and corticosteroids, but the ocular complications can be managed with artificial tears and lubricating ointments, emphasizing the need for interdisciplinary care.

Key considerations in managing Ramsey Hunt syndrome with potential ocular involvement include:

• Prompt initiation of antiviral therapy, such as acyclovir or valacyclovir, to address the viral cause
• Use of corticosteroids, like prednisone, to reduce inflammation
• Implementation of eye protection measures, including artificial tears during the day and lubricating ointment with eye patching at night, to prevent exposure keratitis
• Urgent ophthalmologic evaluation if symptoms of eye pain, redness, or vision changes occur, indicating possible corneal damage

Given the potential for serious ocular complications, it is crucial for patients with Ramsey Hunt syndrome to seek immediate medical attention if they experience any signs of eye involvement, such as pain, redness, or changes in vision, to prevent long-term damage and ensure the best possible outcomes, as the primary goal is to minimize morbidity, mortality, and improve quality of life 1.

From the Research

Ramsey Hunt Syndrome and Ophthalmological Symptoms

• Ramsey Hunt syndrome is a special form of herpes zoster that can be characterized by peripheral facial palsy and unilateral herpetic vesicles on the ear, often accompanied by vestibulocochlear dysfunction and other neurological and ophthalmological symptoms 2.
• The syndrome can involve the ophthalmic division of the fifth cranial trigeminal nerve, leading to ocular disease, including conjunctivitis, keratitis, and uveitis 3.
• Ocular involvement requires urgent ophthalmic consultation, and early recognition and timely treatment with antivirals may prevent ocular complications 3.

Ophthalmologist Emergency

• Herpes zoster ophthalmicus (HZO) is a subset of herpes zoster with involvement of the ophthalmic division of the fifth cranial trigeminal nerve, and approximately 50% of patients with HZO develop ocular disease 3.
• Due to the potential for vision impairment, ocular involvement requires urgent ophthalmic consultation, making it an ophthalmologist emergency 3, 4.
• Ramsay Hunt syndrome can also involve the III, IV, and VI pairs of cranial nerves and I branch of the trigeminal nerve, leading to various ocular manifestations 4.

Treatment and Prevention

• Combination treatment containing anti-viral agents and steroids is recommended for the treatment of Ramsay Hunt syndrome 2, 5.
• Early diagnosis and adequate combination therapy can improve the prognosis of the disease 2, 5.
• Vaccination against herpes zoster can prevent the disease and its ocular complications, including Ramsay Hunt syndrome 3.