American Board of Internal Medicine (ABIM) Certification Practice Exam

Which type of conjunctivitis is associated with herpes zoster rash involving the ophthalmic division of the 5th cranial nerve?

1. Viral conjunctivitis

2. Herpes zoster conjunctivitis

3. Bacterial conjunctivitis

4. Allergic conjunctivitis

The correct answer is: Herpes zoster conjunctivitis

The type of conjunctivitis associated with herpes zoster rash involving the ophthalmic division of the fifth cranial nerve is herpes zoster conjunctivitis. This condition arises when the varicella-zoster virus, which causes herpes zoster (shingles), reactivates in the sensory ganglia and affects the nerve pathways. When the ophthalmic division is involved, the skin lesions can occur around the eye, and the virus can spread to the conjunctiva, leading to conjunctivitis. This conjunctivitis often presents with symptoms such as redness, tearing, and discharge and may occur alongside typical rash symptoms of herpes zoster, including vesicular lesions in the dermatome supplied by the affected nerve. Other types of conjunctivitis, like viral conjunctivitis, are caused by different viral pathogens such as adenoviruses and do not correlate specifically with herpes zoster. Bacterial conjunctivitis is caused by bacterial infections and typically has distinct symptoms and causative agents, while allergic conjunctivitis stems from hypersensitivity reactions to allergens and does not involve viral infections. Therefore, herpes zoster conjunctivitis is specifically linked to the varicella-zoster virus’s effect on the ocular region, marking it as the correct response in this context.