Tzanck smear: A rapid diagnostic tool for pediatric herpes zoster ophthalmicus

Herpes zoster ophthalmicus (HZO) is an uncommon manifestation of varicella-zoster virus reactivation in immunocompetent children, typically presenting with a unilateral vesicular rash along the ophthalmic division of the trigeminal nerve. This report describes a presentation of HZO in a 10-year-old immunocompetent male, characterized by vesicular lesions sparing the forehead and confined to the nasal bridge, initially misattributed to an insect bite. Ocular involvement was evident, and diagnosis was confirmed via Tzank smear. Prompt initiation of oral and topical antiviral therapy resulted in complete resolution within 1 week. This case underscores the diagnostic challenges posed by atypical dermatomal distributions and the critical role of cytological evaluation in pediatric HZO.