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Mun and Jung: Clinical Features and Risk Factors of Herpes Zoster Ophthalmicus
Original Article

Journal of the Korean Ophthalmological Society 2017; 58(12): 1317-1324.

Published online: 14 December 2017

DOI: https://doi.org/10.3341/jkos.2017.58.12.1317

Clinical Features and Risk Factors of Herpes Zoster Ophthalmicus

Chi Young Mun, MD, Moon Sun Jung, MD, PhD

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

Address reprint requests to Moon Sun Jung, MD, PhD. Department of Ophthalmology, Soonchunhyang University Cheonan Hospital, #31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea. Tel: 82-41-570-2260, Fax: 82-41-592-3810, inmydream@schmc.ac.kr

Received 13 July 2017       Revised 29 September 2017       Accepted 29 November 2017

©2017 The Korean Ophthalmological Society

The Korean Ophthalmological Society

(open-access):

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 evaluate the clinical characteristics and risk factors of severe manifestation of herpes zoster ophthalmicus.

Methods

We conducted a retrospective analysis using medical records from 106 patients diagnosed with herpes zoster ophthalmicus from January 2012 to June 2015. Patients were classified according to the type and frequency of ophthalmologic manifestations. Patients with conjunctivitis, punctate keratitis, and pseudodendritic keratitis were classified into the mild group, whereas patients with deep stromal keratitis, endothelitis, scleritis, glaucoma, and extraocular muscle paralysis were classified into the severe group. The age, sex, severity, location of skin lesions, delayed time to treatment, the presence of Hutchinson's sign, and associated systemic diseases were compared between the groups. In addition, we investigated changes in vision, intraocular pressure, treatment duration, recurrence and the prevalence of postherpetic neuralgia.

Results

The incidence of conjunctivitis (47.2%), punctate keratitis (42.5%), pseudodendritic keratitis (12.2%), deep stromal keratitis (12.2%), endothelitis (15.1%), scleritis (18.9%), glaucoma (14.2%), and extraocular muscle (EOM) paralysis (4.7%) were observed in these patients. The group with mild disease included 70 cases with conjunctivitis, punctate keratitis and pseudodendritic keratitis. The severe group included 36 cases with deep stromal keratitis, endothelitis, scleritis, glaucoma and EOM palsy. Disease most often occurred in the distribution of the first branch of the trigeminal nerve, with no differences in the age or sex of patients in both groups. Severe manifestations were more common when a greater extent of the skin was involved, when Hutchinson's sign was present, or when treatment was significantly delayed. There were no significant differences between the two groups in recurrence or the presence of postherpetic neuralgia.

Conclusions

Long-term treatment for herpes zoster opthalmicus is more likely to be required if severe manifestation of disease exists, such as widespread skin involvement, Hutchinson's sign, or a delay to the initiation of antiviral treatment. More active observation and treatment are required in such cases.

Keywords: Herpes zoster ophthalmicus, Hutchinson's sign, Ocular manifestation

Figures and Tables

Figure 1

Frequency of ocular manifestation in patients with herpes zoster ophthalmicus (n = 106). The incidende of conjunctivitis and punctate epithelial keratitis was 47% and 42%, respectively. The other diseases was found to be 10% to 20%. EOM palsy was the lowest at 4.72%.EOM = extraocular muscle.

jkos-58-1317-g001
Table 1

Demographics and clinical characteristics of herpes zoster ophthalmicus patients in the mild and severe groups

jkos-58-1317-i001

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

V1, V2 = first, second division of fifth cranial nerve; HTN = hypertension; DM = diabetes mellitus.

*Independent sample t-test; †Pearson's Chi-square test; ‡Fisher's exact test.

Table 2

Risk factors and comorbidities affecting occurrence in severe ocular manifestation

jkos-58-1317-i002

OR = odds ratio; CI = confidence interval; HTN = hypertension; DM = diabetes mellitus.

*Univariate/†Multivariate Logistic Regression test.

Table 3

Changes in BCVA and IOP before and after treatment by each group

jkos-58-1317-i003

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity; IOP = intra ocular pressure.

*Paired t-test; †Independent t-test.

Table 4

Mean treatment duration and disease progression

jkos-58-1317-i004

Values are presented as mean ± SD unless otherwise indicated.

PHN = postherpetic neuralgia; EOM = extraocular muscle.

*Independent-sample t-test; †Fisher's exact test; ‡Pearson's Chi-square test.

Notes

Conflicts of Interest The authors have no conflicts to disclose

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