Herpes zoster ophthalmicus
Alternate names[edit | edit source]
HZO; Herpes zoster ophthalmicus (HZO)
Definition[edit | edit source]
Herpes zoster ophthalmicus occurs due to the reactivation of the latent varicella-zoster virus. It is a variation of herpes zoster that can cause a variety of ocular complications and requires urgent treatment.[1][1].
Epidemiology[edit | edit source]
- In the United States, herpes zoster affects about 1 per 1000 individuals annually.
- However, in the over 60-years population, the incidence is closer to 1 per 100 individuals.
- The incidence in older adults is lower in those who have received either the live attenuated or inactivated recombinant zoster vaccines.
- Among patients diagnosed with herpes zoster, some epidemiological studies estimate about 8% to 20% are complicated by HZO, with many of those cases resulting in ocular involvement.
Cause[edit | edit source]
- In those with a history of prior infection, the VZV normally lies dormant within a dorsal root ganglion.
- In a healthy individual, immunity acquired from the initial infection allows suppression of the virus.
- However, often in the setting of weakened immunity, the virus may reactivate in the form of herpes zoster, also known as shingles.[2][2].
Risk factors[edit | edit source]
- The main risk factors for HZO include age over 50-years-old and immunocompromised status (e.g., history of HIV, autoimmune diseases requiring corticosteroids or other immunosuppressants, organ or bone marrow transplant, or chemotherapy treatment).
- Other chronic diseases, acute illnesses, and physical and emotional stressors can also precipitate HZO.
Signs and symptoms[edit | edit source]
- Patients with HZO typically present with prodromal pain in a unilateral V1 dermatomal distribution, followed by an erythematous vesicular or pustular rash to the same area.
- Pain is neuropathic, and patients may describe the sensation as "burning" or "shooting", sometimes accompanied by paresthesias.
- Additionally, the herpetic rash may be preceded by constitutional symptoms such as fever, fatigue, malaise, and headaches.
- The presence of herpetic lesions around the tip of the nose is known as the Hutchinson sign.
- The presence of Hutchinson sign indicates nasociliary branch involvement of V1, which confers a higher risk for ocular involvement.[3][3].
Diagnosis[edit | edit source]
- HZO is primarily a clinical diagnosis based on history and classic findings on physical and slit-lamp examination.[4][4].
- Additional procedures, such as ocular tonometry and corneal esthesiometry, may be performed for a more thorough evaluation to assess for complications.
- Other diagnostic tests, such as viral cultures, polymerase chain reaction (PCR), and antibody testing, are rarely required to establish a diagnosis of HZO.
Treatment[edit | edit source]
- Treatment for HZO includes prompt initiation of antiviral agents for all patients, as well as supportive care for symptom management.
- Other adjunct therapies, such as antibiotics, topical or systemic corticosteroids, and corneal epithelial debridement, are considered.[5][5].
- Supportive care: Artificial tears, cold compresses, and analgesics may be employed.
- Antiviral agents: Ideally, treatment with systemic antiviral agents should begin within 72 hours of disease onset.
- Antibiotics: Topical antibiotics (e.g., erythromycin ophthalmic ointment) are often administered to help prevent secondary bacterial infection.
- Corticosteroids: Both topical and systemic corticosteroids may be used in disease management.
- Topical aqueous suppressants: These agents are commonly used in combination with topical corticosteroids in the treatment of elevated IOP secondary to HZO.
- Debridement: Ophthalmology may consider debridement in cases of epithelial keratitis.
References[edit | edit source]
- ↑ Minor M, Payne E. Herpes Zoster Ophthalmicus. [Updated 2021 Jan 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557779/
- ↑ Minor M, Payne E. Herpes Zoster Ophthalmicus. [Updated 2021 Jan 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557779/
- ↑ Minor M, Payne E. Herpes Zoster Ophthalmicus. [Updated 2021 Jan 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557779/
- ↑ Minor M, Payne E. Herpes Zoster Ophthalmicus. [Updated 2021 Jan 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557779/
- ↑ Minor M, Payne E. Herpes Zoster Ophthalmicus. [Updated 2021 Jan 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557779/
{Varicella zoster}}
NIH genetic and rare disease info[edit source]
Herpes zoster ophthalmicus is a rare disease.
Herpes zoster ophthalmicus Resources | ||
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