Cornea: herpes zoster ophthalmicus: practice question

A Ophthalmology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Ophthalmology · Cornea: herpes zoster ophthalmicus

Sample item

A 70-year-old man has a painful vesicular rash on the right forehead and scalp, and now a vesicle on the tip of his nose. His right eye is red and photophobic. What does the nasal lesion indicate, and what is the treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Hutchinson sign, indicating nasociliary nerve involvement and a high risk of ocular disease; start oral antivirals and arrange an urgent eye examination

Herpes zoster ophthalmicus is reactivation of varicella-zoster virus in the ophthalmic division of the trigeminal nerve. Vesicles on the tip or side of the nose (Hutchinson sign) show involvement of the nasociliary branch, which also supplies the cornea, and predict ocular complications such as keratitis, uveitis and raised pressure. Treatment is high-dose oral valaciclovir or acyclovir started early, with ophthalmic assessment and topical therapy as needed.

Option by option

  • A. A sign of herpes simplex type 1; reassure

    The distribution and the vesicular pain pattern indicate zoster, not herpes simplex.

  • B. Evidence of bacterial infection; give oral antibiotics only

    The picture is viral, and antibiotics alone do not treat it.

  • C. A trivial sign of no ocular significance; treat with topical steroids

    The sign is clinically important, and steroids alone without antiviral cover are not appropriate.

  • D. Hutchinson sign, indicating nasociliary nerve involvement and a high risk of ocular disease; start oral antivirals and arrange an urgent eye examination (correct)

    Correct. The sign predicts eye involvement, so antivirals and an urgent eye review are needed.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is D, Hutchinson sign, indicating nasociliary nerve involvement and a high risk of ocular disease; start oral antivirals and arrange an urgent eye examination. Herpes zoster ophthalmicus is reactivation of varicella-zoster virus in the ophthalmic division of the trigeminal nerve.

Why is "A sign of herpes simplex type 1; reassure" not the answer?

The distribution and the vesicular pain pattern indicate zoster, not herpes simplex.

Why is "Evidence of bacterial infection; give oral antibiotics only" not the answer?

The picture is viral, and antibiotics alone do not treat it.

Why is "A trivial sign of no ocular significance; treat with topical steroids" not the answer?

The sign is clinically important, and steroids alone without antiviral cover are not appropriate.

What concept does this question test?

It tests Cornea: herpes zoster ophthalmicus in Ophthalmology. Vesicles on the tip or side of the nose (Hutchinson sign) show involvement of the nasociliary branch, which also supplies the cornea, and predict ocular complications such as keratitis, uveitis and raised pressure. Treatment is high-dose oral valaciclovir or acyclovir started early, with ophthalmic assessment and topical therapy as needed.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cornea: herpes zoster ophthalmicus?

Group the red eye by what to examine and what the pupil does. Then use the flashcards and the other Ophthalmology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.