Herpes Zoster Ophthalmicus in Patients Younger than 50 Years Versus 50 Years and Older

Ga Eun Cho; Kyu Ryong Choi; Roo Min Jun

doi:10.3341/jkos.2013.54.1.19

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

Original Article

J Korean Ophthalmol Soc 2013;54(1):19-25.

Published online: 25 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.1.19

Herpes Zoster Ophthalmicus in Patients Younger than 50 Years Versus 50 Years and Older

Ga Eun Cho, MD, Kyu Ryong Choi, MD, PhD, Roo Min Jun, MD, PhD

Department of Ophthalmology, Ewha Womans University School of Medicine, Seoul, Korea

Address reprint requests to Roo Min Jun, MD, PhD Department of Ophthalmology, Ewha Womans University Medical Center #1071 Annyangcheon-ro, Yangcheon-gu, Seuol 158-710, Korea Tel: 82-2-2650-5154, Fax: 82-2-2654-4334, E-mail: jrmoph@ewha.ac.kr

Received 22 June 2012 Accepted 24 July 2012

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 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.

Keywords: Herpes zoster ophthalmicus, Immunity, Ocular complication, Young age

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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.

Figure 2.

Distribution of the age at the time of diagnosis of herpes zoster ophthalmicus by decade.

Figure 3.

Comparison of best-corrected visual acuity (log MAR) between 2 groups.

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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