Comparison of Herpes Zoster Ophthalmicus in Patients 60 Years Older Versus Younger than 60 Years

You Ra Kim; Nam Chun Cho; In Cheon You

doi:10.3341/jkos.2013.54.4.568

Journal List > J Korean Ophthalmol Soc > v.54(4) > 1009641

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Cho, and You: Comparison of Herpes Zoster Ophthalmicus in Patients 60 Years Older Versus Younger than 60 Years

Original Article

J Korean Ophthalmol Soc 2007;54(4):568-573.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.4.568

Comparison of Herpes Zoster Ophthalmicus in Patients 60 Years Older Versus Younger than 60 Years

You Ra Kim, MD, Nam Chun Cho, MD, In Cheon You, MD

Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea

Address reprint requests to In Cheon You, MD Department of Ophthalmology, Chonbuk National University Hospital #20 Geonji-ro, Deokjin-gu, Jeonju 561-721, Korea Tel: 82-63-250-2581, Fax: 82-63-250-1960, E-mail: you2ic@paran.com

Received 10 August 201216 October 2012 Accepted 25 February 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

To analyze and compare the clinical characteristics of patients with herpes zoster ophthalmicus (HZO) by age groups on the basis of the age of 60.

Methods

Medical records of patients with HZO who visited Chonbuk National University Hospital from February 1, 2002 to February 28, 2011 were reviewed. The patients with follow-up of three months or more were divided into two groups: patients under 60 and patients with 60 years old and over. The clinical characteristics between two groups were examined through the analysis of their medical records.

Results

Among a total of 63 patients, 29 patients (46%) were under 60 years old, and 34 patients (54%) were 60 years old and over. Incidence of HZO highest in the sixties. The sex and intrusion of each group showed no difference. Younger patients had a higher incidence of pseudodendrite by HZO (86.2% vs. 58.8%, p = 0.014) compared with older patients who showed a higher incidence of post herpetic neuralgia (13.8% vs. 35.3%, p = 0.046). As patients showed Hutchinson's sign, they often had more ocular complications such as pseudodendrite (100% vs. 64.7%, p < 0.05), uveitis (41.7% vs. 7.8%, p = 0.04), and conjunctivitis (100% vs. 90.2%, p = 0.02).

Conclusions

Herpes zoster ophthalmicus shows different clinical characteristics according to patients' age and requires appropriate treatment. Especially elderly patients showing Hutchinson's sign should be treated early and aggressively enough.

Keywords: Age, Herpes zoster ophthalmicus, Hutchinson's sign, Postherpetic neuralgia, Pseudodendrite

References

1. Ostler HB, Thygeson P. The ocular manifestations of herpes zoster, varicella, infectious mononucleosis, and cytomegalovirus disease. Surv Ophthalmol. 1976; 21:148–59.

2. Ragozzino MW, Melton LJ 3rd, Kurland LT, et al. Population based study of herpes zoster and its sequelae. Medicine (Baltimore). 1982; 61:310–6.

3. Arvin AM. Varicella-zoster virus. Clin Microbiol Rev. 1996; 9:361–81.

4. Arvin A. Aging, immunity, and the varicella-zoster virus. N Engl J Med. 2005; 352:2266–7.

5. Oxman MN. Immunization to reduce the frequency and severity of herpes zoster and its complications. Neurology. 1995; 45:S41–6.

6. Burke BL, Steele RW, Beard OW, et al. Immune responses to varicella-zoster in the aged. Arch Intern Med. 1982; 142:291–3.

7. Cohen PR, Grossman ME. Clinical features of HIV-associated disseminated herpes zoster virus infection: a review of literature. Clin Exp Dermatol. 1989; 14:273–6.

8. Buchbinder SP, Katz MH, Hessol NA, et al. Herpes zoster and human immunodeficiency virus infection. J Infect Dis. 1992; 166:1153–6.

9. Brisson M, Edmunds WJ, Law B, et al. Epidemiology of varicella zoster virus infection in Canada and the United kingdom. Epidemiol Infect. 2001; 127:305–14.

10. Lee HR, Cho BC. A clinical study of herpes zoster ophthalmicus. J Korean Ophthalmol Soc. 1988; 29:387–91.

11. Herpes zoster keratitis, Krachmer JH, Mannis MJ, Holland EJ. Cornea. 2nd ed.Philadelphia: Elsevier Mosby;2005. v. 1. chap. 84.

12. Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005; 352:2271–84.

13. Nagasako EM, Johnson RW, Griffin DR, Dworkin RH. Rash severity in herpes zoster: correlates and relationship to postherpetic neuralgia. J Am Acad Dermatol. 2002; 46:834–9.

14. Liesegang TJ. Herpes zoster ophthalmicus: natural history, risk factors, clinical presentation, and morbidity. Ophthalmology. 2008; 115:S3–12.

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

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

17. Ghaznawi N, Virdi A, Dayan A, et al. Herpes zoster ophthalmicus: comparison of disease in patients 60 years and older versus younger than 60 years. Ophthalmology. 2011; 118:2242–50.

18. Zaal MJ, Völker-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.

19. Gnann JW Jr., Whitley RJ. Clinical practice. Herpes zoster. N Engl J Med. 2002; 347:340–6.

20. Dworkin RH, Portenoy RK. Pain and its persistence in herpes zoster. Pain. 1996; 67:241–51.

21. De Morgas JM, Kierland RR. The outcome of patients with herpes zoster. AMA Arch Derm. 1957; 75:193–6.

22. Kost RG, Straus SE. Postherpetic neuralgia--pathogenesis, treatment, and prevention. N Engl J Med. 1996; 335:32–42.

23. Hope-Simpson RE. Postherpetic neuralgia. J R Coll Gen Pract. 1975; 25:571–5.

24. Hess TM, Lutz LJ, Nauss LA, Lamer TJ. Treatment of acute herpetic neuralgia. A case report and review of the literature. Minn Med. 1990; 73:37–40.

25. Dworkin RH, Schmader KE. Treatment and prevention of post-herpetic neuralgia. Clin Infect Dis. 2003; 36:877–82.

26. Hampton T. When shingles wanes but pain does not: researchers target chronic postherpetic neuralgia. JAMA. 2005; 293:2459–60.

27. Ragozzino MW, Melton LJ 3rd, Kurland LT, et al. Risk of cancer after herpes zoster: a population-based study. N Engl J Med. 1982; 307:393–7.

28. Donahue JG, Choo PW, Manson JE, Platt R. The incidence of herpes zoster. Arch Intern Med. 1995; 155:1605–9.

29. Harpaz R, Ortega-Sanchez IR, Seward JF. Advisory Committee of Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC), Prevention of herpes zoster: recommendations of the Advisory Committee of Immunization Practices (ACIP). MMWR Recomm Rep. 2008; 57:1–30.

30. Kaufman SC. Anterior segment complications of herpes zoster ophthalmicus. Ophthalmology. 2008; 115:S24–32.

31. Kang JH, Kim HB, Sohn JW, et al. Adult immunization schedule recommended by the korean society of infectious diseases, 2007. Infect Chemother. 2008; 40:1–13.

Figure 1.

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

Table 1.

Demographic features and baseline characteristics

Parameters	<60 years (n = 29)	≥60 years (n = 34)	p-value*
Age at diagnosis (years)	45.62 ± 15.86	72.85 ± 7.86	0.00
Gender, female	55.2 (16)	50.0 (17)	0.688
Eye involved, OD	37.9 (11)	47.1 (16)	0.474
Cancer	0 (0)	2.9 (1)	0.36
DM	6.9 (2)	14.7 (5)	0.321
Oral steroid	3.4 (1)	0 (0)	0.326
Immunosuppression	0 (0)	0 (0)	-
Pain at presentation	75.8 (22)	50 (17)	0.033
Hutchinson's sign	3.4 (7)	14.7 (5)	0.35
VA log MAR at present	0.2 ± 0.31	0.51 ± 0.47	0.003
VA log MAR at last visit	0.2 ± 0.33	0.43 ± 0.53	0.041

Values are presented as mean ± SD or % (n).

^* Independent Samples t-test.

Table 2.

Clinical profile and complications of patients aged <60 years versus ≥60 years at the time of herpes zoster ophthalmicus onset

Complications	<60 years (n = 29)	≥60 years (n = 34)	p-value*
Punctate keratitis	44.8 (13)	61.8 (21)	0.184
Pseudodendrite	86.2 (25)	58.8 (20)	0.014
Mucous plaque keratitis	3.4 (1)	0 (0)	0.326
Neurotrophic keratopathy	3.4 (1)	8.8 (3)	0.391
Exposure keratitis	0 (0)	0 (0)	-
Infectious keratitis	0 (0)	0 (0)	-
Uveitis	20.7 (6)	8.8 (3)	0.199
Cataract	0 (0)	0 (0)	-
IIOP	10.3 (3)	2.9 (1)	0.258
Conjunctivitis	96.6 (28)	88.2 (30)	0.212
Scleritis	6.9 (2)	2.9 (1)	0.471
PHN	13.8 (4)	35.3 (12)	0.046
EOMP	0 (0)	0 (0)	-
Skin cicatraction	3.4 (1)	5.9 (2)	0.657

Values are presented as % (n).

IIOP = increased intraocular pressure; PHN = postherpetic neuralgia; EOMP = extraocular muscle palsy.

^* Independent Samples t-test.

Table 3.

Ocular complication difference according to Hutchinson's sign

Complications	Hutchinson's sign (+) (n = 12)	Hutchinson's sign (-) (n = 51)	p-value*
Punctate keratitis	75 (9)	49 (25)	0.097
Pseudodendrite	100 (12)	64.7 (33)	0.000
Mucous plaque keratitis	0 (0)	2 (1)	0.631
Neurotrophic keratopathy	8.3 (1)	5.9 (3)	0.759
Exposure keratitis	0 (0)	0 (0)	-
Infectious keratitis	0 (0)	0 (0)	-
Perforation	0 (0)	0 (0)	-
Uveitis	41.7 (5)	7.8 (4)	0.047
Cataract	0 (0)	0 (0)	-
IIOP	8.3 (1)	5.9 (3)	0.759
Conjunctivitis	100 (12)	90.2 (46)	0.008
Scleritis	8.3 (1)	3.9 (2)	0.526
PHN	25 (3)	25.5 (13)	0.973
EOMP	0 (0)	0 (0)	-
Skin cicatraction	8.3 (1)	3.9 (2)	0.526

Values are presented as % (n).

IIOP = increased intraocular pressure; PHN = postherpetic neuralgia; EOMP = extraocular muscle palsy.

^* Independent Samples t-test.

TOOLS

Similar articles