Ocular manifestations in Herpes Zoster Ophthalmicus

Puri, Lila Raj; Shrestha, GB; Shah, Deepika N.; Chaudhary, Meenu; Thakur, Anchal

doi:10.3126/nepjoph.v3i2.5271

Cited by 32 publications

(17 citation statements)

References 13 publications

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“…In this study, a lower rate of PHN (13.3%) was found than those of previous studies [5],[9],[21]. A higher incidence (17.8%) was reported by Ghaznawi et al [6] in an American series including 112 patients and was statistically significantly higher in the group aged more than 60 years old.…”

Section: Discussioncontrasting

confidence: 60%

Ocular involvement and visual outcome of herpes zoster ophthalmicus: review of 45 patients from Tunisia, North Africa

Kahloun

Attia

Jelliti

et al. 2014

J Ophthal Inflamm Infect

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BackgroundOcular complications of herpes zoster ophthalmicus (HZO) may lead to substantial visual impairment. The purpose of this study was to characterize and analyze ocular involvement and visual outcome of HZO in patients from Tunisia, North Africa. This study is a retrospective chart review of 51 eyes of 45 patients with HZO.ResultsMean age was 44.5 years. Thirty patients (66.7%) were aged over 50 years. Twenty-four patients (53.3%) were male and 21 patients were female (46.7%). There was no statistically significant difference in gender distribution. Initial mean best corrected visual acuity (BCVA) was 20/50. Ocular manifestations included adnexal involvement (58.8%), keratitis (31.4%), keratouveitis (31.4%), isolated anterior uveitis (AU) (29.4%), intraocular pressure elevation (23.5%), oculomotor nerve palsy (5.8%), and optic neuritis (1.9%). Isolated AU (p < 0.001), isolated keratitis (p = 0.001), and intraocular pressure elevation (p = 0.013) were more likely to be concomitant to HZO active skin disease, while keratouveitis occurred more likely more than 1 month after HZO eruption (p < 0.001). AU and keratouveitis were more likely to be associated with age ≥ 50 years (p = 0.001 and p = 0.02, respectively). Ocular complications included neurotrophic keratopathy (1.9%), corneal opacity (5.9%), secondary glaucoma (7.8%), optic atrophy (1.9%), and postherpetic neuralgia (13.3%). Mean follow-up was 12 months. Mean final BCVA was 20/32; it was ≥ 20/40 in 78.4% of the eyes.ConclusionsOur study provided epidemiologic and clinical data of HZO in a Tunisian population. AU and keratitis were the most common ocular complications. Neurotrophic keratopathy was scarce. The overall visual outcome is good, with about three quarters of the treated patients maintaining VA of 20/40 or better.

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Section: Discussioncontrasting

confidence: 60%

Ocular involvement and visual outcome of herpes zoster ophthalmicus: review of 45 patients from Tunisia, North Africa

Kahloun

Attia

Jelliti

et al. 2014

J Ophthal Inflamm Infect

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“…Puri presents findings on 68 cases of HZO sent for eye care. 23 Overall 78% had some type of eye involvement many of which (45.8%) were lid or adnexal findings that are not reported in other HZO studies and are likely to have raised the estimate of eye involvement in HZO. 23 These important studies add information primarily to the global issue of HZO but cannot be compared to our US population based study.…”

Section: Discussionmentioning

confidence: 71%

“…17,26 Investigators often report on HZO without regard to eye involvement. 15,16,23 Other publications report on HZO as HZ only with confirmed eye involvement. 1,21,22,26 In our study, we found more than three times as many cases of HZ considered to be in the dermatome for HZO than cases of HZO that actually involved the eye by ophthalmologists’ confirmation.…”

Section: Discussionmentioning

confidence: 99%

Herpes Zoster Eye Complications: Rates and Trends

Yawn

Wollan

Sauver

et al. 2013

Mayo Clinic Proceedings

138

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Purpose To provide population based data on the risk, types and outcomes of eye involvement in herpes zoster (HZ). Methods A cohort study based on medical record review of patients diagnosed with HZ between January 1, 1980 and December 31, 2007. HZ was confirmed by typical rash and symptoms or laboratory testing and eye involvement was confirmed by ophthalmologists’ evaluation. Information was collected on all eye diagnoses, all HZ eye related visits, treatments, procedures and outcomes. Results Of the 2035 individuals with HZ in any dermatome, 184 patients (9.0%) had eye involvement. Mean age of the 184 was 62.6 with 5 cases in patients <21. Overall, 6.5% were immune suppressed at the time of the eye complications. The rate of increase of HZ eye involvement was 23% by decade from 1980 to 2007. Common eye complications were keratitis (76.2%), uveitis/iritis (46.6%) and conjunctivitis (35.4%). Recurrent keratitis and recurrent iritis/uveitis occurred in 6.9% and 7.4% respectively. Outcomes included six (3.3%) patients with new vision decrements to 20/200 or worse. Two individuals had successful corneal transplants. Another six (3.3%) individuals had lid ptosis that affected vision including one elderly woman with a permanent unilateral tarsorrhaphy. Severe HZ eye pain was reported to be directly responsible for one unsuccessful suicide attempt. No one developed ARN. A mean of 10.8 HZ eye visits per HZ patient with eye involvement were reported over a mean of 308 days. Conclusion Eye complications are common, result in significant health care utilization and in permanent vision decrement in about 6.6% of individuals with HZ eye involvement. Most health care utilization and long term adverse outcomes were in patients in whom administration of HZ prevention with the zoster vaccine would be possible.

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“…Eyelids (45.8%) are the most common site of ocular involvement, followed by the conjunctiva (41.1%). 72 Corneal complication and uveitis may be present in 38.2% and 19.1% of cases, respectively. 72 Patients with suspected eyelid or eye involvement or those presenting with Hutchinson sign (vesicles at the tip of the nose, which has high correlations with corneal involvement) should be referred for a thorough ophthalmic evaluation.…”

Section: Infectious Conjunctivitismentioning

confidence: 99%