Herpes Zoster Eye Complications: Rates and Trends

Abstract

Purpose To provide population based data on the risk, types and outcomes of eye involvement in herpes zoster (HZ). Methods A cohort study based on medical record review of patients diagnosed with HZ between January 1, 1980 and December 31, 2007. HZ was confirmed by typical rash and symptoms or laboratory testing and eye involvement was confirmed by ophthalmologists’ evaluation. Information was collected on all eye diagnoses, all HZ eye related visits, treatments, procedures and outcomes. Results Of the 2035 individuals with HZ in any dermatome, 184 patients (9.0%) had eye involvement. Mean age of the 184 was 62.6 with 5 cases in patients <21. Overall, 6.5% were immune suppressed at the time of the eye complications. The rate of increase of HZ eye involvement was 23% by decade from 1980 to 2007. Common eye complications were keratitis (76.2%), uveitis/iritis (46.6%) and conjunctivitis (35.4%). Recurrent keratitis and recurrent iritis/uveitis occurred in 6.9% and 7.4% respectively. Outcomes included six (3.3%) patients with new vision decrements to 20/200 or worse. Two individuals had successful corneal transplants. Another six (3.3%) individuals had lid ptosis that affected vision including one elderly woman with a permanent unilateral tarsorrhaphy. Severe HZ eye pain was reported to be directly responsible for one unsuccessful suicide attempt. No one developed ARN. A mean of 10.8 HZ eye visits per HZ patient with eye involvement were reported over a mean of 308 days. Conclusion Eye complications are common, result in significant health care utilization and in permanent vision decrement in about 6.6% of individuals with HZ eye involvement. Most health care utilization and long term adverse outcomes were in patients in whom administration of HZ prevention with the zoster vaccine would be possible.

Systematic review of incidence and complications of herpes zoster: towards a global perspective

“…The reported risk of these eye complications in patients with HZO ranged widely from approximately 30% to 78% 125–129. In a population-based study in the USA, the risk of HZO with eye involvement among patients with HZ was 2.5% 130. The HZ-associated eye complications required an average of 10 months of medical care with 6% of cases resulting in vision loss 130…”

Herpes zoster ophthalmicus and varicella zoster virus vasculopathy

“…Following HZO, ocular complications associated with poor visual outcomes include acute corneal lesions, retinitis, optic neuritis, and uveitis (26) . Patients may also develop postherpetic neuralgia, scleritis, or ocular palsies (27) . Overall, these may cause permanent visual loss and substantial health care utilization.…”

Herpes zoster ophthalmicus: declining age at presentation

“…Herpes zoster ophthalmicus (HZO) is the reactivation of VZV involving the dermatomes supplied by the first branch (V1) of the trigeminal nerve ganglion with ocular involvement. The ocular complications of HZO are many, and include acute and postherpetic neuralgia, vesicular dermatitis and preseptal cellulitis, orbital cellulitis, epithelial keratitis (including infectious corneal pseudodendrites), stromal and endothelial keratitis, neurotrophic keratopathy with or without ulceration, uveitis, glaucoma from trabeculitis, retinitis, choroiditis and optic neuritis 1 2…”