Journal List > J Korean Ophthalmol Soc > v.54(1) > 1009566

Cho, Choi, and Jun: Herpes Zoster Ophthalmicus in Patients Younger than 50 Years Versus 50 Years and Older

Abstract

Purpose

To study the clinical course of herpes zoster ophthalmicus (HZO) and to compare the demographics, treatments, and outcomes in patients under 50 years of age versus patients 50 years of age or older at the time of diagnosis.

Methods

A retrospective chart review was performed of 102 patients who were diagnosed with HZO between January 1, 2008 and December 31, 2010. Baseline demographics and clinical characteristics between patients with an onset of HZO under the age of 50 years and patients with an onset of HZO at the age of 50 years or older were compared.

Results

Similar numbers of patients were affected with HZO in the younger and older age groups (n = 44, 43.1%, vs. n = 58, 56.9%). The mean ± SD of age was 50.6 ± 21.8 years (range, 3–89 years) and the most common decade of HZO onset was between 50 and 59 years. Gender and disease laterality were not statistically different between the 2 groups. No significant difference was found regarding the presence of any ocular manifestation between the groups; however, anterior uveitis was more frequent in the younger patients (p = 0.04). The number of patients with immunosuppressive therapy was higher in the younger age group (p = 0.01).

Conclusions

HZO-affected patients under the age of 50 years and older than 50 years were equally distributed, with the most common decade of onset between the age of 50 and 59 years. Younger patients had a higher incidence of anterior uveitis and immunosuppressive therapy due to underlying systemic diseases.

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Figure 1.
Vesicular lesions over the V1 (ophthalmic nerve) distribution, consistent with the diagnosis of herpes zoster ophthalmicus. (A) 7-year-old female patient with herpes zoster ophthalmicus involving the left nasociliary dermatome. Note the lesions at the side of the tip of the nose (Hutchinson sign). (B) 55-year-old female patient with herpes zoster opthalmicus limited to the frontal nerve dermatome.
jkos-54-19f1.tif
Figure 2.
Distribution of the age at the time of diagnosis of herpes zoster ophthalmicus by decade.
jkos-54-19f2.tif
Figure 3.
Comparison of best-corrected visual acuity (log MAR) between 2 groups.
jkos-54-19f3.tif
Table 1.
Demographic features and baseline characteristics
Parameters <50 years ≥50 years p-value
Number of patient% (n) 43.1 (44) 56.9 (58) N/A
Age at diagnosis (yrs), mean ± SD 29.6 ± 12.5 66.5 ± 11.4 <0.001*
Gender, female% (n) 36.4 (16) 48.3 (28) 0.23
Eye involved, OD% (n) 54.5 (24) 56.9 (33) 0.81
Interval between first symptom and first visit (Days) 4.02 ± 2.1 4.8 ± 2.3 0.74
Immunosuppressive therapy % (n) 11.4 (5) 0 (0) 0.01
Cancer % (n) 2.3 (1) 5.2 (3) 0.45
HIV % (n) 2.3 (1) 0 (0) 0.24
Diabetes mellitus % (n) 0 (0) 15.5 (9) 0.01
Hypertension % (n) 2.3 (1) 60.3 (35) <0.001
Hepatitis B % (n) 0 (0) 5.2 (3) 0.14
No medical history % (n) 75.0 (33) 36.2 (21) <0.001

HIV = human immunodeficiency virus.

* Independent samples t-test

Chi-square test.

Table 2.
Treatment profile of acute herpes zoster ophthalmicus
Treatment <50 years ≥50 years p-value*
Inpatients % (n) 53.5 (21) 45.0 (24) 0.52
Systemic antiviral therapy % (n) 100.0 (44) 100.0 (58) N/A
Systemic antiviral within 72 hrs % (n) 50.0 (22) 36.2 (21) 0.16
Topical antiviral % (n) 86.4 (38) 86.2 (50) 0.98
Topical steroid % (n) 43.2 (19) 43.1 (25) 0.39
Duration of follow‐ up (day), mean ± SD SD 24.6 ± 64.1 57.9 ± 138.1 0.15

* Independent samples t-test.

Table 3.
Ocular manifestation of herpes zoster ophthalmicus in 2 groups divided by age 50
Ocular manifestation <50 years ≥50 years p-value*
Eyelid eruption 86.4% (38) 81.0% (47) 0.32
Conjunctivitis 68.2% (30) 60.3% (35) 0.52
Keratitis 50.0% (22) 50.0% (29) 1.0
Anterior uveitis 25.0% (11) 10.3% (6) 0.04
EOM palsy 2.3% (1) 0.0% (0) 0.24
Scleritis 6.8% (3) 1.7% (1) 0.19
Retinal lesion 0.0% (0) 0.0% (0) N/A
Increased IOP 2.3% (1) 0.0% (0) 0.24

EOM = extraocular muscle; IOP = intraocular pressure.

* Independent samples t-test.

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