Background and Aims Ophthalmoplegia in herpes Zoster is quite rare. At the same time, we observed a case of relapse of herpes Zoster with the clinic of ptosis of the upper eyelid on the background of a pronounced pain syndrome without vesicular rashes as the primary clinical signs. Relief of pain syndrome against the background of antiviral therapy is one of the primary tasks. To evaluate the effectiveness of pterygopalatine blockade (PPB) in the algorithm of treatment of atypical ophthalmic herpes Zoster with severe pain syndrome and ophthalmoplegia.

Methods Patient 60 years old. Complaints about OS blepharoptosis, pain (VAS = 4). The edge of the OS eyelid is lowered to the upper edge of the pupil, the cornea is transparent, there are no signs of uveitis. The condition is regarded as ganglionitis n.ophtalmicus of unknown etiology. The patient underwent PPB (4 mL ropivacaine 0.5%) for pain relief in herpetic ophthalmic neuralgia

Results 40 minutes after PPB, the pain was relieved, VAS = 0. 2 hours after PPB, the ptosis decreased. After 72 hours the patient had a draining herpetic rash on the skin in the projection of the III branch of the trigeminal nerve on the left. Further treatment of the patient was continued by an infectious disease specialist.

Conclusions The experience gained in the use of the PPB in the algorithm for the treatment of ophthalmic complications of herpes Zoster allowed us to achieve not only the relief of pain, but also to reduce the severity of the inflammatory reaction of extraocular muscles, ptosis.