Herpes Zoster Optic Neuropathy

Kaufman, Aaron R.; Myers, Eileen M.; Moster, Mark L.; Stanley, Jennifer; Kline, Lanning B.; Golnik, Karl C.

doi:10.1097/wno.0000000000000607

Cited by 22 publications

(28 citation statements)

References 30 publications

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“…Systemic corticosteroids are also indicated for facial palsy, cranial polyneuritis, and severe inflammatory ocular complications. Topical corticosteroids treat disciform keratitis, endotheliitis, anterior uveitis, and optic neuropathy [5], [16]. However, the use of corticosteroid is controversial because it will increase risk of ocular complications, thinning and perforation of cornea, secondary glaucoma, and reactivated dendriform keratitis [5].…”

Section: Treatmentmentioning

confidence: 99%

Human Vaccines and Herpes Zoster Ophthalmicus: Clinical Manifestation, Treatment, and Prevention

Yuwanda¹

2020

Open Access Maced J Med Sci

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Herpes zoster ophthalmicus (HZO) is a reactivation of HZ virus that is latent in ophthalmic division of trigeminal ganglion. Patients over 50 years old, premature infant, pregnancy woman, receiving immunosuppressive agents, and malignancies are at risk of having HZO. Ocular manifestations of HZ are ectropion, entropion, ectopic eyelash, keratitis, conjunctivitis, symblepharon, hypoesthesia, episcleritis, scleritis, scleral atrophy and thinning, uveitis, iris atrophy, posterior synechiae, acute retinal necrosis, progressive outer retinal necrosis, retinal detachment, retina atrophy, optic neuritis, optic atrophy, and strabismus. Polymerase chain reaction, antigen detection, and antibody detection can help to confirm diagnosis. Pharmacology treatments for HZ ophthalmicus are antiviral drugs, corticosteroids, analgesics, tricyclic antidepressants, and antiepileptic drug. Non-pharmacology therapies are scleral contact lens, phototherapeutic keratectomy, photorefractive keratectomy, and penetrating keratoplasty. There are two kinds of vaccination which can be given to patients: Live-attenuated varicella zoster vaccine and recombinant zoster vaccine. It is recommended by Centers for Disease Control and Prevention and Food and Drugs Administration to use recombinant zoster vaccine by 50 years old.

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Section: Treatmentmentioning

confidence: 99%

Human Vaccines and Herpes Zoster Ophthalmicus: Clinical Manifestation, Treatment, and Prevention

Yuwanda¹

2020

Open Access Maced J Med Sci

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“…It has been suggested that early treatment with antivirals has a better outcome. [ 9 ] Our patient presented 2 days after experiencing visual loss and ptosis. Earlier institution of intravenous acyclovir might have improved the prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…HZO is known to occur more frequently in patients with immunosuppression. [ 8 ] Despite a few anecdotal reports,[ 1 3 6 9 ] it has not been proven conclusively that OAS secondary to HZO occurs more commonly in immune deficient patients. It has been suggested that early treatment with antivirals has a better outcome.…”

Section: Discussionmentioning

confidence: 99%

More than meets the eye: Varicella zoster virus-related orbital apex syndrome

Jun

Gupta

Miléa

et al. 2018

Indian J Ophthalmol

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A 67-year-old male patient with poorly controlled type-2 diabetes mellitus developed an orbital apex syndrome and anterior cavernous syndrome secondary to herpetic zoster ophthalmicus (HZO), despite being on oral acyclovir. Urgent treatment with intravenous acyclovir led to improvement of the orbital and ocular inflammation but had no effect on the complete ophthalmoplegia and profound visual loss. At the 9-month follow-up visit, the patient had complete unilateral ophthalmoplegia and monocular blindness due to optic atrophy.

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“…However, there is growing evidence that antiviral therapy combined with systemic corticosteroids may be more effective in treating the sequelae of HZO [11]. In a recent retrospective study, 9 of 12 patients with HZO-related optic neuropathy experienced improved visual outcomes after receiving adjuvant corticosteroid therapy [12]. Furthermore, there are multiple reports of delayed onset ophthalmoplegia after antiviral treatment, indicating that antiviral therapy alone may not be sufficient to prevent the neurologic complications of HZO [13].…”

Section: Discussionmentioning

confidence: 99%

Severe Bilateral Photophobia and Unilateral Abducens Nerve Palsy: An Unusual Presentation of Herpes Zoster Ophthalmicus

Seddon

Skolnick²

2021

Case Rep Ophthalmol

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Herpes zoster ophthalmicus (HZO) is an uncommon neurocutaneous condition resulting from reactivation of the varicella zoster virus in the ophthalmic division of the trigeminal nerve. Typical presentation of HZO includes a characteristic painful vesicular dermatomal rash. However, the appearance of isolated neurologic complications in the absence of ocular findings has not been previously emphasized. We observed a 47-year-old female patient with established HZO who presented with 1 week of worsening bilateral photophobia and double vision following completion of antiviral treatment. Her motility examination revealed near-complete abduction deficit of her left eye with no other signs of neurologic deficit. Slit lamp biomicroscopy, magnetic resonance imaging, and all laboratory tests were negative. After 2 tapering cycles of oral corticosteroid treatment, her photophobia resolved, and ophthalmoplegia significantly improved. The failure of antiviral therapy in preventing our patient’s neurologic sequelae highlights the importance of concurrent steroid therapy in suspected HZO patients. Furthermore, the resolution of symptoms following administration of systemic glucocorticoids supports consideration of HZO complications as immune-mediated. Finally, the unusual presentation of bilateral photophobia in the absence of ocular inflammation warrants further investigation into the pathogenesis of HZO.

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Herpes Zoster Optic Neuropathy

Cited by 22 publications

References 30 publications

Human Vaccines and Herpes Zoster Ophthalmicus: Clinical Manifestation, Treatment, and Prevention

Human Vaccines and Herpes Zoster Ophthalmicus: Clinical Manifestation, Treatment, and Prevention

More than meets the eye: Varicella zoster virus-related orbital apex syndrome

Severe Bilateral Photophobia and Unilateral Abducens Nerve Palsy: An Unusual Presentation of Herpes Zoster Ophthalmicus

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