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  • Title: Isolated, complete paralytic mydriasis secondary to herpes zoster ophthalmicus.
    Author: Czyz CN, Bacon TS, Petrie TP, Justice JD, Cahill KV.
    Journal: Pract Neurol; 2013 Jun; 13(3):183-4. PubMed ID: 23487825.
    Abstract:
    Herpes zoster ophthalmicus is a manifestation of herpes zoster when the ophthalmic division of the trigeminal nerve becomes involved. Ocular symptoms are varied and mainly due to inflammatory mechanisms. Total, external and/or internal ophthalmoplegias, as well as isolated third, fourth and sixth cranial nerve palsies have all been reported as complications. In a minority of cases, concurrent pupillary paralysis has been documented. The presentation of complete paralytic mydriasis as the sole cranial nerve complication following herpes zoster ophthalmicus infection is a rare finding. The postulated pathophysiologic aetiology is a partial third nerve palsy with the pupillary fibres for light and accommodation-convergence affected and motor fibres spared. The mechanism responsible for the postulated lesion is speculative.
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