J Korean Ophthalmol Soc.  2017 Dec;58(12):1317-1324. 10.3341/jkos.2017.58.12.1317.

Clinical Features and Risk Factors of Herpes Zoster Ophthalmicus

• Mun CY
• Jung MS

• KMID: 2397845
• DOI: http://doi.org/10.3341/jkos.2017.58.12.1317

Abstract

PURPOSE
To evaluate the clinical characteristics and risk factors of severe manifestation of herpes zoster ophthalmicus.
METHODS
We conducted a retrospective analysis using medical records from 106 patients diagnosed with herpes zoster ophthalmicus from January 2012 to June 2015. Patients were classified according to the type and frequency of ophthalmologic manifestations. Patients with conjunctivitis, punctate keratitis, and pseudodendritic keratitis were classified into the mild group, whereas patients with deep stromal keratitis, endothelitis, scleritis, glaucoma, and extraocular muscle paralysis were classified into the severe group. The age, sex, severity, location of skin lesions, delayed time to treatment, the presence of Hutchinson's sign, and associated systemic diseases were compared between the groups. In addition, we investigated changes in vision, intraocular pressure, treatment duration, recurrence and the prevalence of postherpetic neuralgia.
RESULTS
The incidence of conjunctivitis (47.2%), punctate keratitis (42.5%), pseudodendritic keratitis (12.2%), deep stromal keratitis (12.2%), endothelitis (15.1%), scleritis (18.9%), glaucoma (14.2%), and extraocular muscle (EOM) paralysis (4.7%) were observed in these patients. The group with mild disease included 70 cases with conjunctivitis, punctate keratitis and pseudodendritic keratitis. The severe group included 36 cases with deep stromal keratitis, endothelitis, scleritis, glaucoma and EOM palsy. Disease most often occurred in the distribution of the first branch of the trigeminal nerve, with no differences in the age or sex of patients in both groups. Severe manifestations were more common when a greater extent of the skin was involved, when Hutchinson's sign was present, or when treatment was significantly delayed. There were no significant differences between the two groups in recurrence or the presence of postherpetic neuralgia.
CONCLUSION
Long-term treatment for herpes zoster opthalmicus is more likely to be required if severe manifestation of disease exists, such as widespread skin involvement, Hutchinson's sign, or a delay to the initiation of antiviral treatment. More active observation and treatment are required in such cases.

Keyword

Herpes zoster ophthalmicus; Hutchinson's sign; Ocular manifestation

MeSH Terms

Conjunctivitis
Glaucoma
Herpes Zoster Ophthalmicus*
Herpes Zoster*
Humans
Incidence
Intraocular Pressure
Keratitis
Medical Records
Neuralgia, Postherpetic
Paralysis
Prevalence
Recurrence
Retrospective Studies
Risk Factors*
Scleritis
Skin
Time-to-Treatment
Trigeminal Nerve

Figure

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  Figure 1 Frequency of ocular manifestation in patients with herpes zoster ophthalmicus (n = 106). The incidende of conjunctivitis and punctate epithelial keratitis was 47% and 42%, respectively. The other diseases was found to be 10% to 20%. EOM palsy was the lowest at 4.72%.EOM = extraocular muscle.

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