Herpes zoster ophthalmicus with ocular involvement in overtreated hyperthyroidism

A 25-year-old man, with a history of hyperthyroidism presented with herpes zoster ophthalmicus (HZO) with neurotrophic ulcer and superadded infection 4 weeks after a sudden decrease in his thyroid hormones, caused by overtreatment of hyperthyroidism and radioactive iodine therapy. He underwent lateral tarsorrhaphy and was started on conservative treatment for the ulcer. The ulcer had resolved after 2 months. HZO is caused by reactivation of varicella-zoster virus by a decline in cell-mediated immunity. The decrease in thyroid hormones can also reactivate varicella-zoster by immunosuppression. This case highlights the importance of stability in thyroid hormones in a patient with thyroid disease and history of varicella.