Herpes Zoster Opthalmicus–Related Ophthalmoplegia: Anatomical, Pathogenetic, and Therapeutic Perspectives

Abstract

Objective: To investigate the anatomical, pathogenetic, and pharmacological characteristics of herpes zoster ophthalmicus (HZO)-related ophthalmoplegia. Methods: Case report-based systematic review was performed.Results: This study included 96 patients (54 [56.25%] women and 42 [43.75%] men [P = 0.221]). The mean age at presentation was 64.32 ± 17.48 years. All the patients included in the study had HZO-related ophthalmoplegia, with rash presenting as initial symptom in 87 (90.62%) cases, and diplopia in 9 (9.38%) cases. Thirty-seven (38.54%) patients achieved complete recovery, whereas 59 (61.46%) patients had permanent ophthalmoplegia. Females recovered in 26/54 cases and males in 11/42 cases (P = 0.028). Recovery rates after peroral versus intravenous antivirals (15/38 versus 19/46) and > 10 days versus ≤10 days antiviral treatment (22/54 versus 12/30) did not significantly differ (P = 0.865 and P = 0.947, respectively). immunocompetent patients treated with corticosteroids had significantly better recovery rates compared to immunodeficient counterparts (17/34 [50.00%] and 5/22 [22.73%], respectively [P = 0.041]). Conclusions: The outcome of HZO-related ophthalmoplegia is associated with gender, immune status, corticosteroid use, and time of antiviral treatment initiation.

Accelerated Recovery: The Role of Oral Steroid in the Management of Herpes Zoster Ophthalmicus-Related Ophthalmoplegia

“…Notably, prior reports demonstrated comparable recovery rates between oral and intravenous antiviral therapies, irrespective of treatment duration surpassing 10 days or being 10 days or less [ 3 ]. The role of corticosteroids in treating HZORO remains controversial.…”

“…The role of corticosteroids in treating HZORO remains controversial. A recent systemic review highlighted a more favorable prognosis for women, immunocompetent individuals, and those administered corticosteroids [3].…”

“…In HZORO, while approximately 90% of cases manifest with rashes, less than 10% exhibit diplopia [ 3 ]. The sites affected causing motility impairments encompass muscles and neurons across multiple levels, including the orbital apex, cavernous sinus, and central nervous system [ 1 ].…”

“…The sites affected causing motility impairments encompass muscles and neurons across multiple levels, including the orbital apex, cavernous sinus, and central nervous system [ 1 ]. These impairments result from various mechanisms such as viral cytopathic effects, immune responses, and vasculitis [ 1 , 3 ]. Our case presented with ipsilateral pupil-sparing oculomotor palsy, which occurred despite the initiation of antiviral treatment.…”

“…Despite the variability in presentations, ophthalmoplegia in otherwise healthy HZO cases often holds a favorable prognosis, with notable improvement typically observed over a few months. However, the effectiveness of antiviral treatment, with or without steroids, remains uncertain, lacking earlier randomized clinical trials [2][3][4][5]. In this reported case, a patient diagnosed with HZORO is detailed, outlining the management and course of the disease.…”