Journal List > J Korean Ophthalmol Soc > v.51(2) > 1008715

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



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


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.


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.


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


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*
Keratitis Iridocyclitis
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 (%)
Decreased visual acuity Improved or unchanged visual acuity
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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