Ocular motor nerve palsies are common in patients with herpesvirus reactivation. The palsies are caused by an ischemic vasculitis affecting the ocular motor nerves along with the trigeminal nerve. On rare occasions, a tumor in the cavernous sinus can produce ophthalmoplegia and skin manifestations of herpesvirus infection.
Report of a Case.
—An 82-year-old man was found by a family member to be mildly confused and complaining of right orbital pain. On examination he had a fever of 39.8°C and herpetic vesicles on the right side of the nose and upper lip. Skin testing disclosed mild hypoesthesia involving the right ophthalmic (V1) and maxillary (V2) trigeminal divisions. Visual acuity was 20/20 OU. The patient was unable to open his right eye (Fig 1). It was completely ophthalmoplegic with a fixed 6.5-mm pupil.The patient's ophthalmoplegia was initially attributed to herpesvirus. However, a computed tomographic scan performed 2 days later
Horton JC, Wilson CB, Hoyt WF. Herpes Reactivation and Ophthalmoplegia From Pituitary Adenoma Invading the Cavernous Sinus. Arch Ophthalmol. 1991;109(3):323-324. doi:10.1001/archopht.1991.01080030025022