Acute orbital myositis heralding herpes zoster ophthalmicus: report of a case.

We report a rare case that developed orbital myositis before appearance of zoster rashes. A 54 year-old man came to our hospital with a 4-day history of left orbital shooting pain extending to left temporal area. Neurological examinations demonstrated mild left proptosis and hyperemic conjunctiva without ophthalmoplegia. Brain magnetic resonance imaging (MRI) revealed left orbital myositis and periorbital skin eruptions appeared two days after this MRI study. The symptoms were improved after antiviral therapy and a follow-up MRI showed resolution of orbital myositis. Herpes zoster ophthalmicus may present as acute orbital myositis preceding skin eruptions and the recovery of orbital myositis was excellent in these patients. Our patient had postherpetic neuralgia which did not develop in previously reported cases. We conclude that herpes zoster should be listed as a cause of orbital myositis even without skin rashes.