The Clinical Characteristics of Facial Herpes Zoster in Korean Patients

Hyun Joon Lee; So Young Kim; Moon Sun Jung

doi:10.3341/jkos.2010.51.1.8

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Lee, Kim, and Jung: The Clinical Characteristics of Facial Herpes Zoster in Korean Patients

Original Article

J Korean Ophthalmol Soc 2010;51(1):8-13.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.1.8

The Clinical Characteristics of Facial Herpes Zoster in Korean Patients

Hyun Joon Lee, MD, So Young Kim, MD, Moon Sun Jung, MD

Department of Ophthalmology, Soonchunhyang University, College of Medicine, Cheonan, Korea

Address reprint requests to Moon Sun Jung Department of Ophthalmology, Soonchunhyang University Cheonan Hospital #23-20 Bongmyeong-dong, Cheonan 330-721, Korea Tel: 82-41-570-2260, Fax: 82-41-576-2262, E-mail: greenizy@lycos.co.kr

Received 21 April 2009 Accepted 22 September 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 investigate the clinical characteristics of Korean patients with facial herpes zoster.

Methods

The present study enrolled patients with facial involvement among the patients with herpes zoster. The percentage of involved branches of the trigeminal nerve, types and frequency of ocular complications, and changes in visual acuity depending on systemic treatment were analyzed.

Results

A total of 146 patients (15.9%) out of 916 patients with herpes zoster were diagnosed with facial herpes zoster. The ophthalmic branch was the most frequently involved (55.5%), and coinfection with the ophthalmic and maxillary branch was also common (31.5%). Ocular complications developed in 82 eyes (56.2%) and were most common in the group of coinfection with the ophthalmic and maxillary branch (Fisher's exact test, p=0.003). Conjunctivitis (72.0%) was the most commonly observed ocular complication, while punctate keratitis and endothelitis were also frequent. After treatment with a systemic antiviral agent, visual acuity was significantly improved (paired t test, p=0.001).

Conclusions

A higher incidence of ophthalmic complications was observed in facial herpes zoster patients with a wider area of involvement, including the ophthalmic branch. There was significant improvement of visual acuity and ocular complications after systemic treatment. Therefore, systemic antiviral treatment should be considered when a broad herpes zoster skin lesion is observed.

Keywords: Facial herpes zoster, Ocular complication, Trigeminal nerve, Systemic treatment

References

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Figure 1.

Age distribution of patients. Distribution of patients with ocular involvement (n=82) and facial involvement (n=146).

Figure 2.

Distribution of cranial nerve involvement (n=146)

Figure 3.

Proportion of ocular involvement in each cranial nerve.

Table 1.

Correlation between the frequency of ocular complications and involved area

Involved area	No complication	complication	p^*
V1 (n=81)	20	61	0.059
V1+V2 (n=46)	6	40	0.003
V1+V2+V3 (n=2)	0	2	0.358

When more branches of trigeminal nerve were involved, ocular complications occurred more frequently.

^* Fisher's exact test

^† Pearson correlation, r=0.472, p<0.001.

Table 2.

Comparison of the complications of eyes with herpes zoster in Korea (n=82) versus USA

Complication	Korea (%)	USA (%)¹
Conjunctivitis	72.0	^*
Punctate keratitis	59.8	50
Endothelitis	29.3	35
Corneal infiltration	18.3	40
Pseudodendrite	8.5	50
Mucous plaque	4.9	10
Extraocular muscle palsies	7.3	14∼33
Scleritis	3.7	1
Post. herpetic neuralgia	20.7	10∼30
Glaucoma	7.3	^*
Recurrence	11.0	^*

^* No data.

Table 3.

Ocular complications in local and systemic treatment group

	Local treatment	Systemic treatment
Without Complication (n=61)	18	43
With complication (n=85)	10	75
Total	28	118

Ocular complications were more frequent in systemic treatment group than local treatment group.

^* Chi square test, p=0.004

Table 4.

Comparison of uncorrected visual acuity (UCVA) in systemic and local treatment group

	UCVA^*		p^†
	Pre-treatment	Post-treatment	p^†
Systemic treatment	0.385±0.360	0.289±0.309	0.001
Local treatment	0.295±0.281	0.302±0.224	0.071
p^‡	0.004	0.641	

The improvement of UCVA was observed in systemic treatment group but there was no change in local treatment group.

^* LogMAR uncorrected visual acuity

^† paired t-test

^‡ independent t-test.

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