Ocular Manifestations of Herpes Zoster Ophthalmicus

Yoo-Ri Chung; Yoon-Hee Chang; Dae Hee Kim; Hong Seok Yang

doi:10.3341/jkos.2010.51.2.164

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Chung, Chang, Kim, and Yang: Ocular Manifestations of Herpes Zoster Ophthalmicus

Original Article

J Korean Ophthalmol Soc 2010;51(2):164-168.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.2.164

Ocular Manifestations of Herpes Zoster Ophthalmicus

Yoo-Ri Chung, MD, Yoon-Hee Chang, MD, Dae Hee Kim, MD, Hong Seok Yang, MD

Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea

Address reprint requests to Hong Seok Yang, MD Department of Ophthalmology, Ajou University School of Medicine #San 5 Wonchon-dong, Youngtong-gu, Suwon 443-729, Korea Tel: 82-31-219-5256, Fax: 82-31-219-5259, E-mail: yhs0816@naver.com

Received 30 September 2009 Accepted 22 December 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze ocular manifestations of herpes zoster ophthalmicus and evaluate risk factors and complications affecting visual acuity.

Methods

Ocular, cutaneous, and systemic findings were analyzed retrospectively from the medical records of 81 patients, admitted between 1994 and 2007, to the dermatology Department of our hospital for the management of herpes zoster ophthalmicus.

Results

Herpes zoster ophthalmicus was manifested as eyelid eruption (93%), conjunctivitis (80%), keratitis (67%), iridocyclitis (36%), secondary glaucoma (20%), or extraocular muscle palsy (1%). Some patients had accompanying systemic illnesses, including malignancy, hepatitis, diabetes mellitus, chronic obstructive pulmonary disease, tuberculosis, and cerebrovascular disease. Patients with decreased vision during the follow-up period were statistically more likely to have presented with keratitis (p=0.032). However, 86% of these patients recovered vision over a 6-month period.

Conclusions

Patients presenting with keratitis upon initial evaluation are at risk for decreased vision and require appropriate ophthalmic evaluation and management.

Keywords: Herpes zoster ophthalmicus, Keratitis, Visual acuity

References

1. Lee HR, Cho BC. A clinical study of herpes zoster ophthalmicus. J Korean Ophthalmol Soc. 1988; 29:387–90.

2. Lee WB, Liesegang TJ. Herpes zoster keratitis. Krachmer JH, Mannis MJ, Holland EJ, editors. Cornea. 2nd ed.Philadelphia: Elsevier Mosby;2005. 1:chap.p. 84.

3. Korea External Eye Disease Society. Herpes zoster ophthalmicus. Korea External Eye Disease Society. Cornea. 2nd ed.Seoul: Ilchokak;2005. chap. 7.

4. Zaal MJ, Volker-Dieben HJ, D'Amaro J. Visual prognosis in immunocompetent patients with herpes zoster ophthalmicus. Acta Ophthalmol Scand. 2003; 81:216–20.

5. Yoshida M, Hayasaka S, Yamada T, et al. Ocular findings in aberrations patients with varicella-zoster virus infection. aberrations. 2005; 219:272–5.

6. Kaiserman I, Kaiserman N, Nakar S, Vinker S. Herpetic eye disease in diabetic patients. Ophthalmology. 2005; 112:2184–8.

7. Liesegang TJ. Herpes zoster virus infection. Curr Opin aberrations. 2004; 15:531–6.

8. Wipf JE, Paauw DS. Ophthalmologic emergencies in the patient with diabetes. Endocrinol Metab Clin North Am. 2000; 29:813–29.

9. Jude E, Chakraborty A. Images in clinical medicine. Left sixth cranial nerve palsy with herpes zoster ophthalmicus. N Engl J Med. 2005; 353:e14.

10. Hahn ES, Jung YC, Chang K. A case of herpes zoster ophthalmicus complicated by abducens palsy. J Korean Ophthalmol Soc. 1989; 30:447–52.

11. Shin HM, Lew H, Yun YS. A case of complete ophthalmoplegia in herpes zoster ophthalmicus. Korean J Ophthalmol. 2005; 19:302–4.

12. Lee HJ, Kim SY, Jung MS. The clinical characteristics of facial herpes zoster in Korean patients. J Korean Ophthalmol Soc. 2010; 51:14–21.

13. Zaal MJ, Volker-Dieben HJ, D'Amaro J. Prognostic value of Hutchinson's sign in acute herpes zoster ophthalmicus. Graefes Arch Clin Exp Ophthalmol. 2003; 241:187–91.

Figure 1.

Ocular manifestations of herpes zoster ophthalmicus.

Table 1.

Systemic illnesses accompanying herpes zoster ophthalmicus

Systemic illness	Number of patients
Malignancy	5
Diabetes mellitus	7
B-viral hepatitis	5
Tuberculosis	4
Chronic obstructive pulmonary disease	2
Cerebrovascular disease	3
Others	8

Table 2.

Presence of Hutchinson's sign and ocular manifestations of herpes zoster ophthalmicus

Hutchinson's sign	Number of patients	Eyelid eruption	Eyelid eruption and ocular lesions		Increased IOP^*
Hutchinson's sign	Number of patients	Eyelid eruption	Keratitis	Iridocyclitis	Increased IOP^*
Positive	7	7	4	2	1
Negative	74	68	50	27	15

^* IOP=intraocular pressure.

Table 3.

Incidence of ocular manifestations and systemic illness with changes in visual acuity

Condition	Number of patients (%)		p-value
Condition	Decreased visual acuity	Improved or unchanged visual acuity	p-value
Hutchinson's sign	3/21 (14)	4/60 (7)	0.291
Keratitis	19/21 (90)	35/60 (58)	0.032^*
Iridocyclitis	10/21 (48)	19/60 (32)	0.194
Increased IOP^†	6/21 (29)	10/60 (17)	0.071
Systemic illness	9/21 (43)	25/60 (42)	0.063

^* Multiple Logistic Regression test; significance determined by p value less than 0.05

^† IOP=intraocular pressure.

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