Complicated zoster

Disseminated zoster (any of the following)^*:

Extensive cutaneous involvement (eg, >2 contiguous dermatomes, bilateral involvement [lesions crossing the midline], involvement of non-contiguous dermatomes)
Visceral involvement

Ocular manifestations (either of the following)^¶:

Herpes zoster ophthalmicus, suggested by:
- Tearing, ocular pain, blurred vision, conjunctival injection, and/or swelling/erythema of the lid and periorbital structures
- Uveitis, episcleritis, and/or keratitis
Acute retinal necrosis, suggested by:
- Blurred vision
- Acute iridocyclitis (may have "ciliary flush" - injection that gives the appearance of a red ring around the iris)

Ramsay Hunt syndrome:

Triad of ipsilateral facial paralysis, ear pain, and vesicles in the auditory canal and/or auricle. Other symptoms may include tinnitus or nystagmus.

Neurologic complications (any of the following):

* Disseminated zoster almost always occurs in those who are immunocompromised.

¶ All patients with suspected ocular disease should be managed in conjunction with an ophthalmologist.

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