Clinical Spectrum of Herpes Zoster Involving the Ophthalmic, Maxillary and Mandibular Divisions of the Trigeminal Nerve: A Multidisciplinary Case Series

Abstract

Herpes zoster (HZ) is an acute vesiculobullous disease caused by the reactivation of latent varicella-zoster virus (VZV) in individuals with a previous history of varicella infection. The trigeminal nerve is the most frequency affected cranial nerve in herpes zoster. Although herpes zoster ophthalmicus is a well-recognized clinical entity because of its potential ocular complications, involvement of the maxillary and mandibular divisions, either independently or in combination with the ophthalmic division, is relatively uncommon and may present with varied mucocutaneous and oral manifestations. This case series includes patients with herpes zoster involving the trigeminal nerve diagnosed between August 2025 and August 2026. The clinical spectrum involving the ophthalmic, maxillary, and mandibular divisions, along with the associated oral manifestations, ocular findings, and therapeutic management, is described. Early recognition of the characteristic dermatomal distribution and prompt initiation of antiviral therapy were essential for reducing disease severity and preventing long-term complications. Through a collaborative approach between Oral Medicine and Ophthalmology, this report emphasizes the importance of interdisciplinary evaluation in recognizing atypical presentations and ensuring comprehensive patient management.

Keywords: Herpes zoster; Varicella-zoster virus; Trigeminal nerve; Herpes zoster ophthalmicus; Oral manifestations; Ocular manifestations; Antiviral therapy; Multidisciplinary management.