The ophthalmic division of the trigeminal nerve is the smallest of the three divisions, providing purely sensory innervation to the forehead, upper face, cornea, and anterior cranial structures. Its corneal branch via the nasociliary nerve makes it the afferent limb of the corneal blink reflex, the most sensitive test of V1 function. Herpes zoster ophthalmicus affects V1, producing shingles vesicles on the forehead and eyelid with potential corneal involvement.
| Origin | Trigeminal ganglion (Gasserian ganglion) |
|---|
Herpes zoster ophthalmicus from V1 zoster reactivation affects up to 20 percent of all herpes zoster cases and produces potentially sight-threatening keratitis when the nasociliary branch (supplying the cornea) is involved — indicated by the Hutchinson sign of vesicles on the tip of the nose. Urgent antiviral therapy is required for ophthalmic zoster to reduce the risk of post-herpetic neuralgia and ocular complications.
V1 dermatomal shingles producing forehead vesicles with corneal involvement risk when the nasociliary branch is affected (Hutchinson sign), managed with urgent antivirals.
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