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ObservationalAmerican journal of ophthalmology · 2026

High-Resolution MRI for Early Diagnosis of Orbital and Neurovascular Involvement in Herpes Zoster Ophthalmicus.

Sophie Espinoza, Marc Labetoulle, Antoine Rousseau … Thien Huong Nguyen

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OphthalmologyObservational

High-resolution MRI findings changed treatment in most zoster ophthalmicus patients with neuro-ophthalmologic symptoms.

High-Resolution MRI for Early Diagnosis of Orbital and Neurovascular Involvement in Herpes Zoster Ophthalmicus.

Sophie Espinoza … Thien Huong Nguyen

American journal of ophthalmology · 2026

Purpose

To characterize high-resolution MRI (high-resolution MRI) findings of orbital, cranial nerve, and vascular involvement in herpes zoster ophthalmicus (herpes zoster ophthalmicus), and to distinguish inflammatory from ischemic patterns in patients with acute neuro-ophthalmologic symptoms.

Methods

Retrospective, single-center observational case series.

n = 20 patients

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Results

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MRI results led doctors to change the treatment plan for most patients

n = 20 patients

More results

Oculomotor disorders were the most common neuro-ophthalmologic manifestation (70%).

High-resolution MRI showed optic perineuritis (optic perineuritis) in 60%, retrobulbar episcleral inflammation in 45%, associated with orbital fat infiltration.

More results

Cavernous sinus enhancement extended to the cisternal segments of CN V, III, VI in approximately 25% of patients.

Optic neuropathy was identified in 10% with diffusion restriction suggesting ischemia.

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Conclusion · 1 of 3

In herpes zoster ophthalmicus with neuro-ophthalmologic deficits, high-resolution MRI frequently reveals perineuritis, myositis, cavernous sinus pachymeningitis, cranial nerve inflammation, and small- or large-vessel vasculopathy.

Conclusion · 2 of 3

Imaging helps differentiate inflammatory from ischemic complications and supports timely, tailored antiviral and adjunctive therapies.

Conclusion · 3 of 3

Early high-resolution MRI, including vessel-wall sequences, should be considered in severe or atypical herpes zoster ophthalmicus presentations.

Post

High-Resolution MRI for Early Diagnosis of Orbital and Neurovascular Involvement in Herpes Zoster Ophthalmicus.

High-resolution MRI findings changed treatment in most zoster ophthalmicus patients with neuro-ophthalmologic symptoms.

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