Natural history of herpes zoster ophthalmicus: predictors of postherpetic neuralgia and ocular involvement.

Abstract

SUMMARY Seventy-one patients presenting with acute herpes zoster ophthalmicus were followed up for six months for a prospective analysis of the natural history of the disease. Acute and chronic ocular complications, nasociliary nerve Standardised assessment forms were completed at presentation and at subsequent visits. Pain was assessed by visual analogue scale (VAS). The patient was asked to look at a 100 mm horizontal line with a zero at one end and three pluses at the other, with the instruction that the latter represented the worst pain he could possibly imagine. He was then asked to indicate with a mark along the line the severity of any pain being experienced at the time of the interview, and a measurement was taken in millimeters. At subsequent interviews a fresh line was presented. Ocular involvement, nasociliary nerve (NCN) involvement at presentation, rash severity, and duration were also assessed.Assessment of pain by a VAS has been shown to be reproducible for the same individual and a method that allows reliable statistical analysis.6 Like all pain assessment it is subjective, and hence direct comparisons between patients cannot be made. However, 353

Assessment of pain in herpes zoster: lessons learned from antiviral trials

“…Also, the primary reason for treating these patients was to prevent ocular complications and not necessarily to avoid or reduce acute or chronic pain, and certainly insufficient numbers will be enrolled to determine effects on ocular complications. The disease course in patients with ophthalmic zoster may differ from the course in patients with other distributions (Harding et al, 1987). It is also difficult to determine whether PHN in this group of patients is the same as in herpes zoster affecting other dermatomes, because lesions within the eye can persist for much longer than cutaneous lesions.…”

“…Indeed, PHN is by far the most common complication of herpes zoster (Hope-Simpson, 1965;Easterbrook and Wood, 1995). As with the disease itself, the incidence of PHN also increases with age (de Moragas and Kierland, 1957;Guess et al, 1985;Harding et al, 1987). For example, PHN (defined as pain at 1 month or more) is relatively unusual in patients under 50 years, yet occurs in around 50% of patients aged 60 years (de Moragas and Kierland, 1957).…”

How should zoster trials be conducted?

“…In the immunocompetent patient the rash of herpes zoster is a relatively short-lived manifestation with, typically, new lesions forming for 3-5 days, scabbing occurring after 7-10 days and complete healing within 2-4 weeks. Complications other than pain are unusual except in the 10-15% of individuals with involvement of the ophthalmic division of the trigeminal nerve (Ragozzino et al, 1982), 50% of whom are likely to develop intraocular complications (Harding, Lipton & Wells, 1987).…”

Comparison of topical and oral acyclovir in early herpes zoster ophthalmicus

“…1 Of affected cases 10-17% are ophthalmic, and this is the second commonest site after thoracic dermatomes.1, 3 Ocular complications at some time after the onset of rash occur with a frequency of around 50% in herpes zoster Qphthalmicus (HZO), with activity persisting for 6 months or more in up to 28% of initially affected eyes. 4 Incidence and severity of ocular complications are not related to age, sex or severity of rash, but involvement of the external division of the nasociliary nerve is signifi cantly associated with the development of ocular compli cations. Complications in HZO are varied,4-R with anterior uveitis being the commonest followed by varieties of kera-titis.…”

“…Up to 93% of patients with HZO experience acute pain.4 Chronic pain occurs in up to 34%,1,1,4,9,10 becoming more frequent with age and rising to 71 % in those aged 80 years and over. 4 Management of HZO remains controversial. Recent attention has centred on the role of antivirals and in par ticular acyclovir in management and prophylaxis.…”