A Rare Case of Orbital Apex Syndrome in Herpes Zoster Ophthalmicus.

Orbital Apex Syndrome (OAS) is a rare complication of Herpes Zoster Ophthalmicus (HZO). We are reporting a case of 65-year-old male who developed OAS following HZO. Patient presented with vesicular rash in the typical dermatomal distribution, severe periocular congestion and limited ocular motility in all gazes along with loss of vision. Soft tissue inflammation improved within 4 weeks of initiation of treatment while ocular motility slowly improved over 3 months. Patient did not gain vision despite receiving systemic steroids and systemic anti-viral medication. Variable improvement in ocular motility and visual function in our patient points towards multiple mechanisms involved in pathogenesis of this disease, some of which are yet to be understood.