Three Cases of Pupil Abnormality in Herpes Zoster Ophthalmicus

Jung Bin Han; Tae Gi Kim; Kyung Hyun Jin

doi:10.3341/jkos.2013.54.9.1452

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Han, Kim, and Jin: Three Cases of Pupil Abnormality in Herpes Zoster Ophthalmicus

Original Article

J Korean Ophthalmol Soc 2013;54(9):1452-1457.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.9.1452

Three Cases of Pupil Abnormality in Herpes Zoster Ophthalmicus

Jung Bin Han, MD, Tae Gi Kim, MD, Kyung Hyun Jin, MD, PhD

Department of Ophthalmology, KyungHee University Medical Center, KyungHee University School of Medicine, Seoul, Korea

Address reprint requests to Kyung Hyun Jin, MD, PhD Department of Ophthalmology, KyungHee University Medical Center, #23 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-872, Korea Tel: 82-2-958-8451, Fax: 82-2-966-7340 E-mail: khjinmd@khmc.or.kr

∗ This study was presented as e-poster at the 106th Annual Meeting of the Korean Ophthalmological Society 2011.

Received 21 December 20125 May 2013 Accepted 17 July 2013

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

We report the occurrence of pupil abnormality in 3 patients with herpes zoster ophthalmicus.

Case summary

Three patients diagnosed with herpes zoster ophthalmicus developed pupil abnormality. (Case 1) A 37-year-old male diagnosed 1 month prior with anterior uveitis secondary to herpes zoster ophthalmicus presented with peripheral corneal erosions, inflammatory cells in the anterior chamber, diffuse iris atrophy, almost fully-dilated pupils, and loss of pupil light reflex in the right eye. (Case 2) A 72-year-old male presented with vesicles on the right side of the face, and dendritic corneal ulcer, and inflammatory cells in the anterior chamber on initial examinations. After 5 days without treatment by his choice, decreased vision, decreased pupil light reflex, and ovoid-shaped pupils developed. (Case 3) A 63-year-old female presented with left ocular pain, vesicles around the left eye, dendritic corneal ulcer, inflammatory cells in the anterior chamber, and isocoric pupils with normal pupil light reflexes. However, in her left eye, the pupillary ruff was partially lost and the pupil was larger than the right pupil after the start of a 3-week treatment regimen. The pupil in Case 2 returned to normal after 1 month, but in cases 1 and 3, no improvements of pupil abnormalities were observed during the follow-up period.

Conclusions

Herein we presented 3 patients that were diagnosed with herpes zoster ophthalmicus and subsequently de-veloped pupil abnormalities. In the cases of pupil abnormalities, checking for a history of herpes zoster ophthalmicus is necessary to make a differential diagnosis.

Keywords: Herpes zoster ophthalmicus, Iridoplegia, Iris atrophy, Pupil, Uveitis

References

1. Liesegang TJ. Herpes zoster ophthalmicus natural history, risk fac-tors, clinical presentation, and morbidity. Ophthalmology. 2008; 115((2 Suppl)):S3–12.

2. Kaufman SC. Anterior segment complications of herpes zoster ophthalmicus. Ophthalmology. 2008; 115((2 Suppl)):S24–32.

3. Lee HJ, Kim SY, Jung MS. The clinical characteristics of facial herpes zoster in korean patients. J Korean Ophthalmol Soc. 2010; 51:8–13.

4. Thean JH, Hall AJ, Stawell RJ. Uveitis in herpes zoster ophthalmicus. Clin Experiment Ophthalmol. 2001; 29:406–10.

5. Ghaznawi N, Virdi A, Dayan A. . Herpes zoster ophthalmicus: comparison of disease in patients 60 years and older versus young-er than 60 years. Ophthalmology. 2011; 118:2242–50.

6. Gupta N, Sachdev R, Sinha R. . Herpes zoster ophthalmicus: disease pectrum in young adults. Middle East Afr J Ophthalmol. 2011; 18:178–82.

7. Kido S, Sugita S, Horie S. . Association of varicella zoster vi-rus load in the aqueous humor with clinical manifestations of ante-rior uveitis in herpes zoster ophthalmicus and zoster sine herpete. Br J Ophthalmol. 2008; 92:505–8.

8. Wang TJ, Hu CC, Lin HC. Increased risk of anterior uveitis following herpes zoster: a nationwide population-based study. Arch Ophthalmol. 2012; 130:451–5.

9. Chung YR, Chang YH, Kim DH, Yang HS. Ocular manifestations of herpes zoster ophthalmicus. J Korean Ophthalmol Soc. 2010; 51:164–8.

10. Tugal-Tutkun I, Otük-Yasar B, Altinkurt E. Clinical features and prognosis of herpetic anterior uveitis: a retrospective study of 111 cases. Int Ophthalmol. 2010; 30:559–65.

11. Miserocchi E, Waheed NK, Dios E. . Visual outcome in herpes simplex virus and varicella zoster virus uveitis: a clinical evaluation and comparison. Ophthalmology. 2002; 109:1532–7.

12. Van der Lelij A, Ooijman FM, Kijlstra A, Rothova A. Anterior uveitis with sectoral iris atrophy in the absence of keratitis: a dis-tinct clinical entity among herpetic eye diseases. Ophthalmology. 2000; 107:1164–70.

13. Womack LW, Liesegang TJ. Complications of herpes zoster ophthalmicus. Arch Ophthalmol. 1983; 101:42–5.

14. Pavan-Langston D. Herpes simplex and herpes zoster keratouvei-tis: diagnosis and management. Bull N Y Acad Med. 1977; 53:731–48.

Figure 1.

Anterior segment photographs and slit-lamp photographs of case 1. Anisocoric pupil was seen in bright (A) and in dim lighting (B). Pupil of the right eye was unresponsive to light in contrast to the pupil of the left eye. (C) Full-dilated pupil of the right eye was unresponsive to light with diffuse atrophic lesions. (D) Small round pupil of the left eye was responsive to light.

Figure 2.

Slit-lamp photographs of case 2. (A) Ovoid shaped pupil of the right eye. There was no atrophic lesion in right eye. (B) Small round pupil of the left eye.

Figure 3.

Slit-lamp photographs of case 3. (A) Small round pupil of the right eye. (B) Small round pupil of the left eye has a larger pupil size than the pupil of the right eye. There is partial loss of pupillary ruff in the left eye.

Table 1.

Comparison of clinical features at first visit

Clinical features	Case 1	Case 2	Case 3
Severity of Herpes zoster dermatitis	Mild	Moderate	Moderate
Follow up period	4 months	4 months	6 months
From diagnosis of herpes zoster ophthalmicus to development of pupil abnormality	Unknown	5 days	7 days
Grade of anterior uveitis	+	+++	++
Iris & pupil	(already treated) Full-dilated pupil with generalized iris atrophy	Mid-dilated ovoid shaped pupil with sectoral palsy	Mid-dilated round pupil with partial loss of pupillary ruff

Recovery of pupil shape at 6 months later - + -

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