Herpes Zoster Ophthalmicus: A Devastating Disease Coming Back with Vengeance or Finding Its Nemesis?

Abstract

Herpes zoster ophthalmicus is a frequent, painful, and debilitating condition caused by the reactivation of the varicella-zoster virus alongside the ophthalmic branch of the trigeminal nerve. Twenty-five percent of adults will develop the disease during their lifetime with the risk increasing to one in two over the age of 50. Herpes zoster ophthalmicus presents with a plethora of ocular manifestations ranging from the characteristic rash in the distribution of the ophthalmic branch of the fifth cranial nerve to more severe keratouveitis, disciform keratitis, and even retinal necrosis. Up to 20% of affected patients develop post-herpetic neuralgia which can persist for years after the acute episode, resulting in potentially devastating consequences for the patient’s social, financial, and professional circumstances, as well as their quality of life and daily activities. Shingles prevention studies indicated that the herpes zoster vaccine markedly reduces the burden of the disease, as well as the incidence of both infection and post-herpetic neuralgia. Here we review the vaccinations available for herpes zoster, the reasons behind their limited adoption so far, as well as the future perspectives and challenges associated with this debilitating disease in the era of herpes zoster vaccination and coronavirus disease pandemic.

Multiple ocular manifestations in a patient diagnosed with herpes zoster ophthalmicus: case report

“…The first one is the live attenuated Zostavax vaccine (ZVX), which is given as a subcutaneous injection and is a one-time vaccination. The second one is a non-live recombinant vaccine, named Shingrix, which is given as two intramuscular injections, 2 to 6 months apart [ 1 , 12 ]. The overall efficacy against the incidence of herpes zoster is 51.3% for ZVX and 97.2% for Shingrix.…”

Herpes Zoster Ophthalmicus: Presentation, Complications, Treatment, and Prevention

“…Initially, ZVL was the only vaccine available. For example, in 2008, the US Advisory Committee on Immunization Practices (ACIP) recommended ZVL for all individuals older than 60 years [ 4 ]. Subsequently, after the US Food and Drug Administration approval of RZV, ACIP recommended that all adults aged ≥ 50 years receive RZV regardless of whether they had previously received ZVL [ 4 , 103 ].…”

“…HZ and HZO can be prevented by vaccination. Without vaccination, 30% of all adults, and 50% of those aged 85 years or older, will develop HZ [4]. However, vaccination with live-attenuated (ZVL) or non-live recombinant adjuvanted vaccine (RZV) significantly reduces the incidence of HZ in older adults who are at high risk of the disease [5][6][7][8].…”

Sensitive Scalp and Trichodynia: Epidemiology, Etiopathogenesis, Diagnosis, and Management

“…Postherpetic neuralgia is the most common complication of herpes zoster and can occur in up to 20% of patients [38, 40]. It is manifested by chronic painful neuropathy in the territory of the affected nerve, which can last for months or years [41].…”