J Korean Ophthalmol Soc.  2013 Sep;54(9):1452-1457.

Three Cases of Pupil Abnormality in Herpes Zoster Ophthalmicus

  • 1Department of Ophthalmology, KyungHee University Medical Center, KyungHee University School of Medicine, Seoul, Korea. khjinmd@khmc.or.kr


We report the occurrence of pupil abnormality in 3 patients with herpes zoster ophthalmicus.
Three patients diagnosed with herpes zoster ophthalmicus developed pupil abnormality. (Case 1) A 37-year-old male diagnosed 1 month prior with anterior uveitis secondary to herpes zoster ophthalmicus presented with peripheral corneal erosions, inflammatory cells in the anterior chamber, diffuse iris atrophy, almost fully-dilated pupils, and loss of pupil light reflex in the right eye. (Case 2) A 72-year-old male presented with vesicles on the right side of the face, and dendritic corneal ulcer, and inflammatory cells in the anterior chamber on initial examinations. After 5 days without treatment by his choice, decreased vision, decreased pupil light reflex, and ovoid-shaped pupils developed. (Case 3) A 63-year-old female presented with left ocular pain, vesicles around the left eye, dendritic corneal ulcer, inflammatory cells in the anterior chamber, and isocoric pupils with normal pupil light reflexes. However, in her left eye, the pupillary ruff was partially lost and the pupil was larger than the right pupil after the start of a 3-week treatment regimen. The pupil in Case 2 returned to normal after 1 month, but in cases 1 and 3, no improvements of pupil abnormalities were observed during the follow-up period.
Herein we presented 3 patients that were diagnosed with herpes zoster ophthalmicus and subsequently developed pupil abnormalities. In the cases of pupil abnormalities, checking for a history of herpes zoster ophthalmicus is necessary to make a differential diagnosis.


Herpes zoster ophthalmicus; Iridoplegia; Iris atrophy; Pupil; Uveitis

MeSH Terms

Anterior Chamber
Corneal Ulcer
Diagnosis, Differential
Follow-Up Studies
Herpes Zoster
Herpes Zoster Ophthalmicus
Middle Aged
Uveitis, Anterior
Vision, Ocular


  • Figure 1. Anterior segment photographs and slit-lamp photographs of case 1. Anisocoric pupil was seen in bright (A) and in dim lighting (B). Pupil of the right eye was unresponsive to light in contrast to the pupil of the left eye. (C) Full-dilated pupil of the right eye was unresponsive to light with diffuse atrophic lesions. (D) Small round pupil of the left eye was responsive to light.

  • Figure 2. Slit-lamp photographs of case 2. (A) Ovoid shaped pupil of the right eye. There was no atrophic lesion in right eye. (B) Small round pupil of the left eye.

  • Figure 3. Slit-lamp photographs of case 3. (A) Small round pupil of the right eye. (B) Small round pupil of the left eye has a larger pupil size than the pupil of the right eye. There is partial loss of pupillary ruff in the left eye.



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