Epidemiology of Herpes Zoster Ophthalmicus

Abstract

Purpose A hospital-based epidemiology study to describe herpes zoster ophthalmicus (HZO) prevalence, and identify risk factors for recurrent and chronic disease. Design Retrospective, hospital-based cohort study Participants All patients evaluated in the Broward and Miami VA Healthcare System (MIAVHS) during the study period. Methods Retrospective medical record review of patients seen in the MIAVHS from January 1, 2010 and December 31, 2014 with a HZO clinical diagnosis. Assessment of the patient's clinical course was defined by the following: an acute episode of HZO was defined as quiescence of disease within 90 days of initial presentation; HZO recurrence was defined as any recurrent eye disease or rash >90 days after quiescence disease was noted off therapy; chronic HZO was defined as active disease persisting greater than 90 days from initial presentation. Main Outcome Measures 1) Frequency of HZ involving the V1 dermatome (HZO) with and without eye involvement; 2) HZO recurrence rates 3) Risk factors for recurrent or chronic HZO. Results 90 patients with HZO were included in the study. The mean age at incident episode of HZO was 68±13.8 years (range, 27-95 years). The majority of patients were white (73%), immune competent (79%), and did not receive zoster vaccination at any time point in their follow up (82%). Patients were followed for a mean of 3.9±5.9 years, (range, 0-33 years). The period prevalence of HZ in any dermatome was 1.1%, the frequency of HZ involving V1 (HZO) was 0.07% and the frequency of HZO with eye involvement was 0.05%. The overall 1, 3, and 5-year recurrence rates for either recurrent eye disease or rash were 8%, 17%, 25%, respectively. Ocular hypertension (HR 4.6, 95% Cl 1.3-16.5; OR 6.7, 95% Cl 1.5-31.2) and uveitis (HR 5.7, 95%CI 1.7-19.0; OR 6.7, 95% C1 1.5-31.2) increased the risk of recurrent and chronic disease. Conclusion This study supports newer data that a significant proportion of patients experience recurrent and chronic HZO. Further study is needed to guide preventative and therapeutic approaches to recurrent and chronic HZO.

Herpes Zoster Ophthalmicus: A Review for the Internist

“…The peak incidence was between the ages of 50 and 79 years, with a skew toward older individuals, with the highest rates observed among patients over age 80 years (10.9 cases per 1000 person-years). 7 The incidence of herpes zoster ophthalmicus, in particular, has not been the subject of a nationwide study; however, both the Miami Veterans Administration Healthcare System and Kaiser Permanente in Hawaii have evaluated their rates of herpes zoster ophthalmicus. 7,8 The Miami study collected data over a span of 4 years, revealing 90 patients with herpes zoster ophthalmicus.…”

“…7 The incidence of herpes zoster ophthalmicus, in particular, has not been the subject of a nationwide study; however, both the Miami Veterans Administration Healthcare System and Kaiser Permanente in Hawaii have evaluated their rates of herpes zoster ophthalmicus. 7,8 The Miami study collected data over a span of 4 years, revealing 90 patients with herpes zoster ophthalmicus. The majority (97%) were immunocompetent, and the frequency of herpes zoster ophthalmicus with eye involvement was 0.05%.…”

“…The majority (97%) were immunocompetent, and the frequency of herpes zoster ophthalmicus with eye involvement was 0.05%. 7 The Kaiser study documented 134 cases in 1 year in a population of 217,061 patients. This is an overall incidence of 30.9 per 100,000 person-years.…”

“…Immunocompromise should always be explored, as herpes zoster is 4-5 times more common in these patients; however, the majority of patients with herpes zoster and herpes zoster ophthalmicus are immunocompetent. 7 Options for treatment include oral acyclovir, famciclovir, and valacyclovir. Famciclovir (500 mg 3 times a day) and valacyclovir (1 g 3 times a day) have been shown to be as effective as acyclovir (800 mg 5 times a day), 15 both in the treatment of herpes zoster and in reduction of complications.…”

A Clinical Study of Ocular Complications of Hiv

“…Frequency data and knowledge of risk factors for recurrence will help in planning clinical trials to test new management strategies such as prolonged antiviral treatment or post-HZO vaccination. 8 It became evident early in the AIDS epidemic that CMV retinitis was a frequent opportunistic infection among patients with AIDS and that it typically occurred in patients with CD4 + T cells (helper T cells) <50 cells/μL. 9 Some of these patients were treated with acyclovir 800 mg 5 times daily for 7 days.…”