Herpes zoster ophthalmicus (HZO) is a reactivation of the varicella zoster virus (VZV) in the ophthalmic division of the trigeminal nerve. Although cutaneous and ocular complications are common, neurological involvement beyond the trigeminal nerve is rare. We report a case of herpes zoster–associated multiple cranial neuritis with simultaneous involvement of the optic, oculomotor, abducens, and trigeminal nerves. The patient presented with acute visual loss, ophthalmoplegia, ptosis and hemifacial sensory loss. MRI showed inflammatory changes affecting the orbital apex. He was treated with intravenous acyclovir and systemic corticosteroids, with partial recovery. This case highlights the importance of recognising VZV as a cause of multiple cranial neuropathies, which may masquerade as orbital apex syndrome.

Herpes zoster ophthalmicus, Orbital apex syndrome, Multiple cranial neuritis, varicella zoster virus (VZV).