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Herpes Zoster OphthalmicusOriginal article contributed by: John
B. Cason MD
All contributors: Brad H. Feldman, M.D.and John B. Cason MD
Assigned editor:Review: Not reviewed
Herpes Zoster Ophthalmicus (HZO), commonly known as shingles, is
a viral disease characterized
by a painful skin rash in one or more dermatome distributions of
the fifth cranial nerve, shared by the
eye and orbit.
Contents[hide]
1 Disease Entity
o 1.1 Disease
o 1.2 Etiology
o 1.3 Risk Factors
o 1.4 General Pathology
o 1.5 Pathophysiology
o 1.6 Primary prevention
2 Diagnosis
http://eyewiki.org/Property%3AAuthorshttp://eyewiki.org/User%3AJohn.B.Cason.CMThttp://eyewiki.org/User%3ABrad.H.Feldman.DEChttp://eyewiki.org/User%3ABrad.H.Feldman.DEChttp://eyewiki.org/User%3AJohn.B.Cason.CMThttp://eyewiki.org/Herpes_Zoster_Ophthalmicushttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Disease_Entityhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Diseasehttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Etiologyhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Risk_Factorshttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#General_Pathologyhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Pathophysiologyhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Primary_preventionhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Diagnosishttp://eyewiki.org/Property%3AAuthorshttp://eyewiki.org/User%3AJohn.B.Cason.CMThttp://eyewiki.org/User%3ABrad.H.Feldman.DEChttp://eyewiki.org/User%3AJohn.B.Cason.CMThttp://eyewiki.org/Herpes_Zoster_Ophthalmicushttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Disease_Entityhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Diseasehttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Etiologyhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Risk_Factorshttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#General_Pathologyhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Pathophysiologyhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Primary_preventionhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Diagnosis
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o 2.1 History
o 2.2 Physical examination
o 2.3 Signs
o 2.4 Symptoms
o 2.5 Clinical diagnosis
o 2.6 Diagnostic procedures
o 2.7 Laboratory test
o 2.8 Differential diagnosis
3 Management
o 3.1 General treatment
o 3.2 Medical therapy
o 3.3 Medical follow up
o 3.4 Surgery
o 3.5 Surgical follow up
o 3.6 Complications
o 3.7 Prognosis
4 Additional Resources
5 References
Disease Entity[edit source]
Disease[edit source]
http://eyewiki.org/Herpes_Zoster_Ophthalmicus#Historyhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Physical_examinationhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Signshttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Symptomshttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Clinical_diagnosishttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Diagnostic_procedureshttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Laboratory_testhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Differential_diagnosishttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Managementhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#General_treatmenthttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Medical_therapyhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Medical_follow_uphttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Surgeryhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Surgical_follow_uphttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Complicationshttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Prognosishttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Additional_Resourceshttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Referenceshttp://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=1http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=1http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=1http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=2http://eyewiki.org/Herpes_Zoster_Ophthalmicus#Historyhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Physical_examinationhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Signshttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Symptomshttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Clinical_diagnosishttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Diagnostic_procedureshttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Laboratory_testhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Differential_diagnosishttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Managementhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#General_treatmenthttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Medical_therapyhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Medical_follow_uphttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Surgeryhttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Surgical_follow_uphttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Complicationshttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Prognosishttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Additional_Resourceshttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#Referenceshttp://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=1http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=2
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Herpes Zoster Ophthalmicus is an ocular disease which usually
manifests as a unilateral painful skin
rash in a dermatomal distribution of the trigeminal nerve shared
by the eye and ocular adnexa. HZO
occurs typically in older adults but can present at any age and
occurs after reactivation of latent
varicella-zoster virus (VZV) present within the sensory spinal
or cerebral ganglia[1].
Etiology[edit source]HZO is caused by the varicella-zoster virus
which has re-activated from its dormant status in the
dorsal ganglion cells of the central nervous system. From there
it may travel along neurons to the
sensory axons of the skin to form vesicular lesions.
Risk Factors[edit source]Virulence of the VZV and the immune
status of the host are primary factors leading to the
development of HZO. The incidence and severity of herpes zoster
increases with advancing age with
patients over the age of 60 at the highest risk.[2]One study
showed that racial factors may play role
since elderly black patients were one fourth as likely as
elderly white patients to develop herpes
zoster.[3]Further supporting the theory that immune system
status plays a role, patients that are
treated with immunosuppressive drugs have a significantly
increased risk for herpes zoster.[4]An
immunocompromised patient is more likely to have a prolonged
illness, more likely to recur, and
more likely to develop myelitis and vasculopathy.[5]The risk of
herpes zoster is 15 times greater in
men with HIV than in men without HIV.[6]
General Pathology[edit source]HZO is a result of activated
varicella zoster virus which is a double-stranded DNA virus in the
herpes
simplex virus group.
Pathophysiology[edit source]Unless the immune system is
compromised the VZV virus is usually suppressed. However, for
reasons that are not fully understood, the virus reactivates
from its dormant state in the sensory
ganglion, replicates in the nerve cells, and sheds virions from
the cells that are carried down the
axons to the skin served by that ganglion. The local immune
response results in skin blisters or
ocular inflammation depending on which tissues are affected.
Perineuritis causes intense pain along
the nerve distribution.[7]Aging, immunosupression therapy, and
psychological stress all could be
factors resulting in reactivation of the virus.[8]
Primary prevention[edit source]
http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-Liesegang_HZO-1http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=3http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=3http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=3http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=4http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=4http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=4http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-chapman-2http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-Schmader-3http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-Schmader-3http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-cohen-4http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-cohen-4http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-Hilt-5http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-Buch-6http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-Buch-6http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=5http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=6http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-7http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-8http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=7http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-Liesegang_HZO-1http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=3http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=4http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-chapman-2http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-Schmader-3http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-cohen-4http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-Hilt-5http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-Buch-6http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=5http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=6http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-7http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-8http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=7
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Avaricella-zostershinglesvaccinationis now recommended for
patients over the age of 60.
Although 90% of the population has prior exposure to VZV, there
appears to be a benefit to booster
immunity especially since the community incidence of native VZV
exposure has decreased. During a
recent study, a 50% decreased incidence of zoster and 66%
reduction of postherpetic neuralgia was
demonstrated.[9]
Diagnosis[edit source]
History[edit source]Herpes zoster is an acute, painful,
vesicular eruption distributed along a single dermatome and is
associated with a prodrome of fever, malaise, headache, and pain
in the dermatome. The vesicles
typically crust and will heal within 2-6 weeks.
Physical examination[edit source]Visual acuity with best
correctionExternal examination of eyelids, periocular skin, and
scalp.
Measurement of intraocular pressureSlit-lamp biomicroscopy of
the anterior segment with special
attention to any staining cornea defects, stroma opacities,
cornea vascularization, and anterior
chamber cell and flare.Dilated examination of the lens, macula,
peripheral retina, optic nerve, and
vitreous.
Signs[edit source]Erythematous skin lesions with macules,
papules, vesicles, pustules, and crusting lesions in the
distribution of the trigeminal nerve. Hutchinsons sign is
defined as skin lesions at the tip, side, or
root of the nose. This is a strong predictor of ocular
inflammation and corneal denervation in HZO,
especially if both branches of the nasociliary nerve are
involved.[10][11]
Symptoms[edit source]Many cases of HZO exhibit a prodromal
period of fever, malaise, headache, and eye pain prior to
eruption of the skin rash. The patient may describe eye
pressure, tearing, eye redness, or decreasing
vision. Pain in the distribution of the trigeminal nerve may be
severe.
Clinical diagnosis[edit source]
http://www.cdc.gov/vaccines/vpd-vac/shingles/http://www.cdc.gov/vaccines/vpd-vac/shingles/http://www.cdc.gov/vaccines/vpd-vac/shingles/http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-Oxman-9http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=8http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=9http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=10http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=10http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=11http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-Hutchinson-10http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-Hutchinson-10http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-Hutchinson-10http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-11http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=12http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=12http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=12http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=13http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=13http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=13http://www.cdc.gov/vaccines/vpd-vac/shingles/http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-Oxman-9http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=8http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=9http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=10http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=11http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-Hutchinson-10http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-11http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=12http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=13
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Dermatome distribution pain and rash with associated ocular
findings strongly suggest HZO. Cornea
epithelial defects, decreased corneal sensation, and ocular
inflammation in any of the layers of the
eye also correlate with the diagnosis. HZO iritis is frequently
associated with high intraocular
pressure.
Diagnostic procedures[edit source]Cornea sensation should be
tested prior to instillation of anesthetic drops. This can be
accomplished
with a Cachet-Bonnet anesthesiometer or with a fine wisp of a
cotton-tip applicator. Decreased
sensation is very suspicious forherpes simplex virus(HSV). Using
fluorescein, cornea epithelial
defects should be ruled out.
Laboratory test[edit source]Cornea scrapings of any skin lesions
may be sent to the laboratory for a Tzanck smear. However,
this test will not differentiate betweenherpes simplex
virus(HSV) and Varicella. Alternatively, cultures
may be sent for immunoflourescence assays to look for IgM
specific to VZV. Viral cultures and
polymerase chain reaction testing may also be obtained to
diagnose VZV.[12]
Differential diagnosis[edit source]Not many disease processes
produce a painful vescicular rash. However, other conditions
that
create vescicular rashes should be considered especially in the
absence of pain: for example,
contact dermatitis and vaccinia dermatitis. Other disease
entities that can mimic cornea findingsinclude recurrent erosion,
noninfectious cornea melts, infectious keratitis. There are
numerous
infectious and non-infectious entities that can exhibit ocular
inflammation in the aqueous, vitreous,
optic nerve, retina, and choroid.
Management[edit source]
General treatment[edit source]Skin rash treatment should prevent
bacterial superinfection. With careful examination inflammation
in
all layers of the eye should be ruled out and treated with
antivirals and steroids if indicated. When a
skin rash is the only clinical sign, follow-up care must be
directed to ruling out any ocular
manifestations that may develop.
http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=14http://eyewiki.org/Herpes_Simplex_Virus_Keratitishttp://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=15http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=15http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=15http://eyewiki.org/Herpes_Simplex_Virus_Keratitishttp://eyewiki.org/Herpes_Simplex_Virus_Keratitishttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-12http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=16http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=16http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=16http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=17http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=18http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=18http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=18http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=14http://eyewiki.org/Herpes_Simplex_Virus_Keratitishttp://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=15http://eyewiki.org/Herpes_Simplex_Virus_Keratitishttp://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-12http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=16http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=17http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=18
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Medical therapy[edit source]Oral acyclovir 800 mg po five times
daily for 7 to 10 days is the standard treatment. Alternatively,
a
provider could use famciclovir 500 mg po tid or valacyclovir
1000mg po tid. If the systemic condition
warrants or if the patient is unable to tolerate food by mouth
then acyclovir 5-10 mg/kg iv q8 for 5days may be utilized.
Topical steroids (e.g. prednisolone acetate 1%) should be used
for interstitial keratitis and uveitis. For
episodes of scleritis, retinitis, choroiditis, and optic
neuritis, systemic steroids by mouth or
intravenous administration should be strongly considered.
For increased intraocular pressure commonly found in herpes
trabeculitis, topical steroids should be
administered as well as aqueous suppressants (e.g. timolol,
brimonidine, dorzolamide,
acetazolamide).
Pain should be treated with narcotics if warranted. Neuropathic
pain responds well to amitriptyline 25
mg po qhs and can decrease the incidence of postherpetic
neuralgia. Capsaicin cream applied to the
rash may decrease pain as well.[13]
Medical follow up[edit source]Depending on the ocular findings
and severity the patient should be monitored every 1 to 7 days
during the acute episode. Monitoring every 3-12 months
afterwards may be helpful to monitor for
delayed sequelae such as ocular hypertension, cataract, and
cornea scarring. If there is any concern
of future exacerbations, viral prophylaxis should be considered
with acyclovir 400 mg po bid.
Surgery[edit source]Cornea transplantationis sometimes required
for lesions that cause severe cornea thinning and loss
of structural integrity of the eye. Scars that are visually
significant and refractory to medical therapy
and/or hard contact lenses may require
transplantation.Vitrectomy/Retina detachment surgerymay
be performed especially in cases of acute retina necrosis
(ARN).Glaucoma filtration surgeryis
sometimes performed if there are difficulties with maintaining
optimum intraocular pressure. If the
intraocular inflammation and/or steroid treatment causes a
cataract then cataract surgery may beperformed when the disease
process is quiescent.
Surgical follow up[edit source]
http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=19http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-13http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-13http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=20http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=20http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=20http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=21http://eyewiki.org/Penetrating_Keratoplastyhttp://eyewiki.org/Penetrating_Keratoplastyhttp://eyewiki.org/Pars_Plana_Vitrectomyhttp://eyewiki.org/Retinal_Detachmenthttp://eyewiki.org/Retinal_Detachmenthttp://eyewiki.org/Retinal_Detachmenthttp://eyewiki.org/Trabeculectomyhttp://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=22http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=22http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=22http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=19http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_note-13http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=20http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=21http://eyewiki.org/Penetrating_Keratoplastyhttp://eyewiki.org/Pars_Plana_Vitrectomyhttp://eyewiki.org/Retinal_Detachmenthttp://eyewiki.org/Trabeculectomyhttp://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=22
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Depending on the type of surgery performed, the patient should
be closely monitored for severe
inflammation commonly associated with herpes after surgical
procedures. Viral prophylaxis with
antiviral therapy and steroids should be strongly
considered.
Complications[edit source]Zoster skin manifestations in the
eyelids can affect the deep dermis. Therefore, cicatrix can result
in
ptosis, lid scarring, ectropion, and entropion. Scleritis can
cause scleral, limbal and corneal atrophy.
Inflammation in the cornea, optic nerve, retina and choroid
could result in permanent vision loss.
Corneal scars commonly affect the vision requiring hard contact
lens or cornea transplantation
interventions. Postherpetic neuraligia occurs in 36.6% of
patients over the age of 60 and in 47.5%
over the age of 70. [11]
Prognosis[edit source]
Prognosis is greatly variable and dependent on long-term
sequelae. Long-term vision loss, need for
surgery, and long-term antiviral prophylaxis are all
possible.
Additional Resources[edit source]CDC Information on Shingles
Vaccination
CDC Information on Varicella Vaccination
References[edit source]
1. Jump up Liesegang TJ. Herpes Zoster Ophthalmicus.
Ophthalmology 2008;115:S3-S12.
2. Jump up Chapman RS, Cross KW, Fleming DM. The incidence of
shingles and its
implications for vaccination policy. Vaccine
2003;21:2541-2547.
3. Jump up Schmader K, George LK, Burchett BM, et al. Racial
differences in the occurrence
of herpes zoster. J Infect Dis 1995;171:701-704.
4. Jump up Cohen PR, Grossman ME. Clinical features of human
immunodeficiency virus-
associated disseminated herpes zoster virus infection a review
of the literature. Clin Exp Dermatol
1989;14:273-276.
http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=23http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=24http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=24http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=24http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=25http://www.cdc.gov/vaccines/vpd-vac/shingles/http://www.cdc.gov/vaccines/vpd-vac/varicella/http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=26http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=26http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=26http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_ref-Liesegang_HZO_1-0http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_ref-Liesegang_HZO_1-0http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_ref-chapman_2-0http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_ref-chapman_2-0http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_ref-Schmader_3-0http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_ref-Schmader_3-0http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_ref-cohen_4-0http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_ref-cohen_4-0http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=23http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=24http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=25http://www.cdc.gov/vaccines/vpd-vac/shingles/http://www.cdc.gov/vaccines/vpd-vac/varicella/http://eyewiki.org/w/index.php?title=Herpes_Zoster_Ophthalmicus&action=edit§ion=26http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_ref-Liesegang_HZO_1-0http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_ref-chapman_2-0http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_ref-Schmader_3-0http://eyewiki.org/Herpes_Zoster_Ophthalmicus#cite_ref-cohen_4-0
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5. Jump up Hilt DC, Bucholz D, Krumholz A, et al. Herpes zoster
ophthalmicus and delayed
contralateral hemiparesis caused by cerebral angiitis: diagnosis
and management approaches. Ann
Neurol 1983;14:543-553.
6. Jump up Buchbinder SP, Katz MH, Hessol NA, et al. Herpes
zoster and human
immunodeficiency virus infection. J Infect Dis
1992;166:1153-1156.
7. Jump up Schmader K. Herpes zoster and postherpetic neuralgia
in older adults. Clin
Geriatr Med 2007;23(3):615-632.
8. Jump up Thomas SL, Hall AJ. What does epidemiology tell us
about risk factors for herpes
zoster?. Lancet Infect Dis 2004;4(1):26-33.
9. Jump up Oxman MN, Levin MJ, Johnson GR. Shingles Prevention
Study Group. A vaccine
to prevent herpes zoster and postherpetic neuralgia in older
adults. N Engl J Med. 2005;352(22):2271-
2284.
10. Jump up Hutchinson J. A clinical report on herpes zoster
ophthalmicus (shingles affecting
the forehead and nose). Trans Am Ophthalmol Soc
1942;40:390-439.
11. Jump up Zaal MJ, Volker-Dieben HJ, DAmarao J. Prognostic
value of Hutchinsons sign in
acute herpes zoster ophthalmicus. Graefes Arch Clin Exp
Ophthalmol 2003;241:187-191.
12. Jump up Burns DA, et al. Rooks Textbook of Dermatology, 7th
Edition.
13. Jump up Kunimoto DY, et al. Wills Eye Manual, 4th
Edition.
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