Hutchinson's sign and its importance in rhinology

Herpes zoster ophthalmicus usually has a typical appearance. However, if the disease is limited to the nasociliary branch of the trigeminal nerve, the ocular appearance may be confusing. Hutchinson in 1865 first noted that involvement of the external nasal branch of the fifth cranial nerve was associated with an increased incidence of ocular zoster. A case of herpes zoster ophthalmicus is presented that clinically resembled an ocular complication of sinus disease. The presence of a localized vesicular rash at the nasal tip assisted in an early diagnosis. Although this sign is known amongst ophthalmologists, its importance in rhinology is stressed. An anatomical explanation of Hutchinson's sign is given and the treatment of herpes zoster ophthalmicus is briefly discussed.