Diagnosis Of Herpes Zoster Ophthalmicus Research Articles

The association of stroke with herpes zoster ophthalmicus.

Studies have reported an association between herpes zoster ophthalmicus (HZO) and stroke. We sought to validate this association with rigorous controls for both medical comorbidities and social factors using a nationwide U.S. administrative medical claims database. A two-step approach was taken: first a retrospective case-control study was performed, followed by a self-controlled case series (SCCS). For the case control study, cox proportional hazard regression with inverse proportional treatment weighting assessed the hazard for stroke. In the SCCS, incidence of stroke was compared prior to and after the diagnosis of HZO. For the case-control study, 25,720 cases and 75,924 controls met our eligibility criteria. 1712 (6.7%) and 4544 (6.0%) strokes occurred in the case and control groups respectively, conferring an 18% increased risk of stroke in the observed 1-year post-HZO period (HR = 1.18, 95% CI: 1.12-1.25, p < 0.001). SCCS analysis showed the risk for stroke was highest in the month immediately after HZO episode compared to any other time range (1-30 days after, relative risk 1.58, p < 0.001) and even higher when assessing time more distal time points prior to the HZO diagnosis (days 1-30 after HZO diagnosis had RR = 1.69 (95% CI: 1.38-2.07) and RR = 1.93 (95% CI: 1.55-2.39) compared with days -120 to -91 and -150 to -121 prior to index, respectively (p < 0.001). After accounting for stroke risk factors, our analysis confirms the association between HZO and stroke, with highest risk in the immediate month after an episode.

Pediatric herpes zoster ophthalmicus: a systematic review.

While typically affecting older adults and immunocompromised individuals, herpes zoster ophthalmicus (HZO) has been reported with varying manifestations and complications in children. In this review, we evaluate reported cases of pediatric HZO in the literature and discuss the epidemiology, risk factors, clinical presentation, treatment and outcomes. A literature search on PubMed, Scopus, and Web of Science databases was performed using the terms "pediatric herpes zoster ophthalmicus" and "herpes zoster ophthalmicus children." Publications that were not specific to HZO or pediatric populations were excluded, as were publications that were not available to review or not published in the English language. Fifty-seven reports describing 130 cases of HZO or HZO-related complications were reviewed. Major risk factors for pediatric HZO included intrauterine exposure to varicella or primary varicella infection at a young age; HZO also occurred in patients who had received varicella vaccination. Both healthy and immunocompromised children were affected, with the majority of affected children being immunocompetent. The diagnosis of HZO is primarily clinical. Children appear to have good vision recovery and resolution of symptoms if they are treated promptly and if they adhere to treatment regimens, except for irreversible vision loss related to uncommon complications such as optic neuritis. HZO occurs in both healthy and immunocompromised children. Recognizing this treatable condition is essential for reducing ocular and systemic morbidity. Long-term follow-up and assessments of the impact on health in adulthood are lacking. More systematic study is needed to determine the incidence of HZO in children and appropriate diagnostic and treatment protocols for the care of pediatric patients with HZO.

Practice Patterns in the Initial Management of Herpes Zoster Ophthalmicus in the United States.

The aims of this study were to examine the trends in the initial management of herpes zoster ophthalmicus (HZO) in the United States from 2010 to 2018 and compare them with the treatment preferences of corneal specialists. A retrospective, observational deidentified cohort study was conducted on individuals enrolled in the OptumLabs Data Warehouse who had a new diagnosis of HZO from 1/1/2010 to 12/31/2018. An online survey ascertaining HZO management perspectives was distributed to The Cornea Society listserv. The main outcome assessed was proportion of cases with systemic antiviral prescriptions, eye care provider involvement, and follow-up visits after the initial HZO diagnosis. Approximately 50% of patients received systemic antivirals the day of initial HZO diagnosis or within 7 days (45.6% and 53.7%, respectively). Most initial diagnoses were made by ophthalmologists (45.0%), followed by optometrists (19.2%). Referral rate to ophthalmology within a year of initial diagnosis was 38.6%. 48.7% cases had at least 1 follow-up visit with any type of provider within 30 days. Our survey of corneal specialists found 97% would prescribe systemic antivirals to those with ocular involvement, but 66% would prescribe antivirals to those without ocular or eyelid involvement. Seventy percent supported all patients having follow-up with an eye care provider within a month. HZO antiviral therapies seem to be underprescribed in the United States, referral rates to ophthalmology are low, and follow-up is suboptimal, which are not aligned with recommendations from corneal specialists. More research is needed to establish standardized guidelines for treatment, referral, and follow-up with ophthalmology for HZO.

Ophthalmic Zoster, A Rare Pathology in a Child

Herpes zoster in children is rare and particularly the ophthalmic form, which can be responsible for serious ocular complications. We report the case of a 6-year-old female patient with herpes zoster ophthalmicus. The patient was 6 years old and hospitalised with a painful rash. The examination revealed an infectious syndrome, a painful vesicular rash, in a cluster, resting on an erythematous background located on the forehead and the root of the nose with eyelid edema. Slit lamp examination came back normal. The diagnosis of herpes zoster ophthalmicus was made on the basis of clinical findings. The course was favourable on acyclovir with no ocular complications and no post-herpetic pain.

Ophthalmic Zoster, A Rare Pathology in a Child

Herpes zoster in children is rare and particularly the ophthalmic form, which can be responsible for serious ocular complications. We report the case of a 6-year-old female patient with herpes zoster ophthalmicus. The patient was 6 years old and hospitalised with a painful rash. The examination revealed an infectious syndrome, a painful vesicular rash, in a cluster, resting on an erythematous background located on the forehead and the root of the nose with eyelid edema. Slit lamp examination came back normal. The diagnosis of herpes zoster ophthalmicus was made on the basis of clinical findings. The course was favourable on acyclovir with no ocular complications and no post-herpetic pain.

Neonatal Herpes Zoster Ophthalmicus: Two Rare Cases

Two neonates one at age of 15 days and another at age of 20 days were presented with redness, watering, periocular and lid swelling, photophobia and vesicular lesions over forehead on right side of face. Ocular examination revealed ciliary and conjunctival congestion, chemosis, and hazy cornea due to stromal edema. Though herpes zoster is very rare in neonates, the diagnosis of herpes zoster ophthalmicus was made on basis of clinical examination and treated with systemic and topical anti-viral, topical antibiotic and corticosteroid. Both neonates showed dramatic response in seven days treatment and completely cured within four weeks. High clinical suspicion in vesiculo-papular lesion of child of any age can help in early diagnose and early treatment can prevent sequelae of HZO.

Neonatal Herpes Zoster Ophthalmicus: Two Rare Cases

Two neonates one at age of 15 days and another at age of 20 days were presented with redness, watering, periocular and lid swelling, photophobia and vesicular lesions over forehead on right side of face. Ocular examination revealed ciliary and conjunctival congestion, chemosis, and hazy cornea due to stromal edema. Though herpes zoster is very rare in neonates, the diagnosis of herpes zoster ophthalmicus was made on basis of clinical examination and treated with systemic and topical anti-viral, topical antibiotic and corticosteroid. Both neonates showed dramatic response in seven days treatment and completely cured within four weeks. High clinical suspicion in vesiculo-papular lesion of child of any age can help in early diagnose and early treatment can prevent sequelae of HZO.

Benefits of telemedicine in diagnosis of herpes zoster ophthalmicus with timely management and follow-up

Sir, Herpes Zoster is caused by the viral reactivation of Varicella Zoster virus, that enters the cutaneous nerve endings during an earlier episode of chicken pox and travels to the Dorsal Root Ganglia and remains latent. It is characterized by the occurrence of vesicular lesions grouped along the Single Dermatome innervated by Dorsal Root of Sensory Ganglion. Herpes Zoster Ophthalmicus (HZO) is involvement of the ophthalmic division of the fifth cranial nerve. It is the second most common type of Herpes Zoster (HZ), after Thoracic Zoster [1]. We present here, a case of Herpes Zoster in a young girl involving Supraorbital, Maxillary and Mandibular of the Trigeminal nerve. Timely diagnosis of HZO was made. The lesion on the tip of the nose (Hutchinson’s sign) alerted the involvement of Nasociliary nerve and to arrange immediate Ophthalmology consultation. Tele-Dermatology helped in reducing waiting time, fast delivery of care and prevention of visual disability [2]. The patient was monitored, motivated and treated, that could happen because of tele- dermatology. Dramatic improvement in the patient was observed in a very short time. The use of tele-dermatology, especially in times of the COVID – 19 pandemic is invaluable. The patient was a girl aged 12-years, presented through telemedicine with 3 days of lesions on the face mimicking acne. On close examination, there were a few Vesicular Lesions among multiple lesions and there was involvement of tip of the nose. Patient also complained of eye pain. This helped us to consider HZO. Prompt immediate treatment with anti-virus was initiated. It was possible to do continuous monitoring with the help of Tele-Medicine and without the patient having to leave the house in COVID era. Patient was advised to consult an Ophthalmologist for further evaluation. As it was essential, for examination of the eye parameters, patient had to attend in person. This one visit was not through Tele-Medicine. Patient was informed on day-1 of treatment that the condition may initially worsen under proper adequate treatment with a graphic representation (Fig. 1) and then decrease later. And this happened in our case, as seen in the six consecutive photographs as indicated below with date and time of the photographs by the patient, which are presented to illustrate the natural progression of disease under proper adequate treatment. This helped in avoiding panic to the patient. The lesions as seen in the pictures became aggressive in two days which means, the eye could have been affected more but for the immediate treatment given. Patient could get treatment from home by consulting online through out, thereby reducing the risk of venturing to a clinic in COVID situation. Except for one visit to the Ophthalmologist which was inevitable. Ocular Manifestations – Ocular manifestations affect about 50% of patients with HZO and can be isolated. This proportion reaches 80% in case of appearance of the Hutchinson Sign. The latter reflects the involvement of the nasociliary branch and is characterized by eruption on the side and on the tip of the nose [3]. Eye examination showed that there was congestion generalized in Conjunctiva. Corneal sensation was reduced, Iris anterior chamber, Pupil, lens, Fundus and extra ocular movements were normal. Immediate treatment was instituted after counselling about the treatment. The patient was advised Valacyclovir 1000 mg, 3 times a day for 7 days along with adequate fluid intake. For relief of pain, patient was given Pregabalin, Tremedol 25 mg and Gabapentin 6%W/W+Lidocaine 5%W/W smooth locally. Eye treatment As per Ophthalmologists advice, Polyethylene glycol 400 0.4% + Propylene glycol 0.3% five times a day and Acyclovir eye ointment a day was prescribed to the patient. All the pictures were taken by the patient and shared with the doctor, during the course of the treatment helping in regular monitoring have been presented (1a – 1f). In this case, Telemedicine gave the scope of reducing waiting time, providing correct diagnosis, enabling faster delivery of care, enabling tele based access to monitor the patient’s condition, counselling, management, monitoring with good end result. Key Takeaways • The importance of (Hutchinson’s sign) involvement of the tip of nose is emphasized. • Counselling the patient with regard to the possibility of worsening of the visible symptoms while under appropriate and adequate treatment, should be given with the help of a graphic representation (Fig. 2). • Prompt referral to Ophthalmologist is necessary. • The consultant and the patient should be conscious of associated potential Vision threatening complications and the need for prompt treatment to protect from visual complications.

Factors associated with age of onset of herpes zoster ophthalmicus.

The aim of this study was to evaluate factors associated with the age of onset of herpes zoster ophthalmicus (HZO) in the era of varicella vaccination. A retrospective series of 400 subjects with a diagnosis of HZO, and an analysis of public health databases. Variables studied included the age at onset, period of disease onset (1996-2004 and 2005-2012), sex, smoking habits, diabetes status, autoimmunity, and immunosuppressed status. Community data were gathered from the Oklahoma Outpatient Surgery Discharge Public Use Data File and the United States Census' American Community Survey data set. The mean onset age was significantly lower for 2005 to 2012 as compared with 1996 to 2004 among females (mean decrease, 9.3 years; 95% confidence interval, 4.6-13.9 years; P < 0.0001), but the mean onset age was similar between the 2 periods among males (P = 0.640). Whereas 32.3% of the patients with zoster were <60 years old in 1996 to 2004, compared with 44.8% in the 2005 to 2012 period (χ test: P = 0.017). In the multivariate model, smokers were found to have disease onset 11.5 (95% confidence interval, 6.9-16.1) years younger than nonsmokers. The proportion of younger patients with HZO increased, whereas the institutional and community data sets demonstrate a downward shift of the average age of onset of HZO among females. This may be an effect of widespread childhood varicella vaccination. Immunosuppression and smoking were also associated with a younger age of onset of HZO. This has implications for clinical care of patients at risk for developing HZO, as well as public health and vaccination policies.

Coinfection with Herpes Zoster Ophthalmicus and Oriental Eye Worm in a Rural Woman: The First Report of an Unusual Case

Dear Editor: A 70-year-old Korean rural woman presented with a 7-day history of painful facial cutaneous lesions and severe ocular pain. Her general condition was good except for hypertension. Upon examination, there was erythema, vesiculobullous lesions and crusted erosions on the right side of the forehead and cheek. Also, there was right-sided periorbital edema confined to the cutaneous surface innervated by the ophthalmic division of the fifth cranial nerve (Fig. 1A). Because the Hutchinson's sign, ocular erythema, and foreign body sensation were present, she was referred to an ophthalmologist. Ophthalmologic examination showed perilimbal and conjunctival injection. No dendritic and inflammatory lesions were observed in the anterior chamber. Therefore, the diagnosis of herpes zoster ophthalmicus (HZO) was made. After admission, intravenous acyclovir (10 mg/kg) and analgesics were administered. However, despite the improvement in her cutaneous lesions and pain, the ocular pain and foreign body sensation persisted. At the second ophthalmologic examination, a chalky-white, 12.4×0.44 mm in size, thread-like worm was found in the right bulbar conjunctiva at the 8 o'clock position (Fig. 2) and it was removed. A parasitologist confirmed that the worm was an oriental eye worm. After 7 days, the initial signs and symptoms subsided. Only scattered crusted scars were observed (Fig. 1B). Fig. 1 (A) Erythema, edema, vesiculobullous eruptions, crusted erosions were present on the right side of the forehead, and yellowish lacrimation was noted from the right orbital area in the initial state and (B) after 7 days of treatment. Note the vesicles ... Fig. 2 A white, slender, thread-like worm (Thelazia callipaeda, 12.4×0.44 mm in size) was removed from the right bulbar conjunctiva of the patient. HZO is defined as herpes zoster involvement of the ophthalmic division of the fifth cranial nerve. Hutchinson's sign is defined as skin lesions at the tip, side, or root of the nose, and it is a strong predictor of ocular inflammation and corneal denervation in HZO1. When the ophthalmic division is affected and Hutchinson's sign is present, unexplained painful ocular injection or visual problems can be observed. And serious visual impairment could also occur2. Nematodes belonging to the genus Thelazia, commonly known as eye worms, infect orbital cavities and associated tissues of several mammals. The two species known to cause human thelaziasis are Thelazia callipaeda and Thelazia californiensis. Thelazia callipaeda is known as the 'oriental eye worm' because of its distribution in countries in the Far East, while Thelazia californiensis is found in the United States3,4. The final hosts of these nematodes include dogs and cats, but occasionally rabbits, monkeys, raccoons, foxes, and humans can also serve as the final host. When a fly licks the tear in the eye of a final host, the larvae enter the conjunctival sac, and become adults in 1 month after 2 molts5. The common symptoms of infestation are itching, tearing, foreign body sensation, and photophobia. Therefore, it is important to include human thelaziasis in the differential diagnosis of bacterial or allergic conjunctivitis. The optimal treatment is removal of the worm by using forceps3,4. In this case, the cutaneous and ocular symptoms in the patient were not only due to HZO but also due to parasitic infestation. Because the Hutchinson's sign was present, we initially thought that her ocular pain was an inevitable symptom of HZO. However, these symptoms completely disappeared only after the removal of the eye worm. In conclusion, we presented an unusual case of coinfection with HZO and oriental eye worm in a rural Korean woman. Human thelaziasis could cause ocular problems similar to HZO, too. Therefore, in cases of refractory HZO, a careful ophthalmologic examination should be considered to exclude other conditions including human thelaziasis, especially in patients living in a rural area or raising domestic animals.

A Herpes zoster ophthalmicus case with partial nerve paralysis of the oculomotor

A 48 years old Caucasian male patient admitted to our clinic with left side blepharoptosis and left periorbital itching complaints. In physical examination, patient’s left upper eyelid was totally ptotic and there was ulcerated periorbital skin lesions in the same side as well. There was a restriction with upward gaze in the left eye. Best corrected visual acuity was 20/100. There was fine keratic precipitates on the central and inferior area of the left endothelium and 3+ reaction in the anterior chamber. Patient was accepted with a diagnosis of herpes zoster ophthalmicus. Treatment was started in our department. Inflammation in the anterior chamber was completely resolved in the second week of treatment and visual acuity was 20/20 in left eye. In the fourth month of patient’s visit, blepharoptosis was resolved but limitation of the upward gaze was not resolved in the examination. According to our knowledge, this case may be the first herpetic involvement of superior divison of the oculomotor nerve in the aspect of clinical signs and may add contribution to the literature.

An interesting case of herpes zoster ophthalmicus

Approximately 20% of the world's population suffers from herpes zoster at least once in a lifetime, with about 10% to 20% of these having an ophthalmic involvement. Timely diagnosis of Herpes Zoster Ophthalmicus (HZO), with an early recognition of its various associated complications as well as their management along with an early referral to an ophthalmologist are critical in limiting visual disability. Here we report an interesting case of HZO in a young individual who in addition to the corneal involvement also had anterior uveitis as well as grossly raised intra ocular pressure

Unilateral Herpes Zoster Ophthalmicus Results in Bilateral Corneal Nerve Alteration: An In Vivo Confocal Microscopy Study

Herpes zoster ophthalmicus (HZO), thought to be a unilateral disease, results in loss of corneal sensation, leading to neurotrophic keratopathy. This study aimed to analyze bilateral corneal nerve changes in patients with HZO by in vivo confocal microscopy (IVCM) and their correlation with corneal sensation as a measure of nerve function. Prospective, cross-sectional, controlled, single-center study. Twenty-seven eyes with the diagnosis of HZO and their contralateral clinically unaffected eyes were studied and compared with normal controls (n = 15). In vivo confocal microscopy (Confoscan 4; Nidek Technologies, Gamagori, Japan) and corneal esthesiometry (Cochet-Bonnet; Luneau Ophthalmologie, Chartres, France) of the central cornea were performed bilaterally in all patients and controls. Patients were grouped into normal (>5.5 cm), mild (>2.5-5.5 cm), and severe (<2.5 cm) loss of sensation. Changes in corneal nerve density, total nerve number, main nerve trunks, branching, and tortuosity were evaluated after IVCM and were correlated to corneal sensation, disease duration, and number of recurrences. Eyes with herpes zoster ophthalmicus had a significant (P<0.001) decrease in total nerve length (595.8±358.1 vs. 2258.4±989.0 μm/frame), total number of nerves (5.4±2.8 vs. 13.1±3.8), number of main nerve trunks (2.3±1.1 vs. 4.7±1.2), and number of nerve branches (3.2±2.3 vs. 8.4±3.7) as compared with controls. In the contralateral clinically unaffected eyes, total nerve length (1053.1±441.4 μm/frame), total number of nerves (8.3±2.9), and main nerve trunks (3.1±1.0) also were decreased significantly as compared with controls (P<0.01). Reduced nerve density, total nerve count, main trunks, and tortuosity was correlated significantly with corneal sensation across all subgroups (P<0.001). Patients with unilateral HZO demonstrated a profound and significant bilateral loss of the corneal nerve plexus as compared with controls, demonstrating bilateral changes in a clinically unilateral disease. Loss of corneal sensation strongly correlated with subbasal nerve plexus alterations as shown by IVCM. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Increased Risk of a Cancer Diagnosis after Herpes Zoster Ophthalmicus: A Nationwide Population-Based Study

Herpes zoster has been associated with immune suppression, as has an increased risk of cancer. This population-based follow-up study aimed to investigate the risk of a subsequent cancer diagnosis after herpes zoster ophthalmicus (HZO). A retrospective cohort study. Retrospective claims data from the Taiwan National Health Insurance Research Database were analyzed. The study cohort comprised all patients with a diagnosis of HZO (International Classification of Diseases, 9th Revision, Clinical Modification code 053.2) in 2003 and 2004 (n=658). The comparison cohort consisted of randomly selected ambulatory care patients, 8 for every patient with HZO (n=5264) matched with the study group on age, gender, monthly income, and urbanization level of the patient's residence. The Kaplan-Meier method was used to compute 1-year cancer-free survival rate. Stratified Cox proportional hazard regressions were carried out to compute the adjusted 1-year cancer-free survival rate after adjusting for potential confounding factors. Subsequent claims for all study and comparison patients were captured over a 1-year follow-up period from their index ambulatory care visit to identify whether the patient received a cancer diagnosis during the follow-up period. During 1-year follow-up, cancer was diagnosed in 4.86% of patients with HZO and 0.53% of patients in the comparison cohort. Patients with HZO had significantly lower 1-year cancer-free survival rates than the comparison cohort. After adjusting for patient age, gender, monthly income, and urbanization level, patients with HZO were found to have a 9.25-fold (95% confidence interval, 5.51-15.55) risk of a subsequent cancer diagnosis than the matched comparison cohort. No significant differences in cancer type were observed between the 2 cohorts. Herpes zoster ophthalmicus may be a marker of increased risk of being diagnosed with cancer in the following year. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Herpes zoster ophthalmicus and the risk of stroke

To investigate the risk of stroke development following a diagnosis of herpes zoster ophthalmicus (HZO). Data were retrospectively collected from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients with a diagnosis of HZO (ICD-9-CM code 053.2) in 2003 and 2004 (n = 658). The comparison cohort was comprised of randomly selected patients (3 for every HZO patient, n = 1974) matched with the study group in terms of age and gender. Patients were tracked from their index visits for 1 year. The Kaplan-Meier method was utilized to compute the 1-year stroke-free survival rate. Cox proportional hazard regressions were carried out to compute the adjusted 1-year stroke-free survival rate after adjusting for possible confounding factors. Stroke developed in 8.1% of patients with HZO and 1.7% of patients in the comparison cohort during the 1-year follow-up period. HZO patients had significantly lower 1-year stroke-free survival rates than patients in the comparison cohort. After adjusting for patients' demographic characteristics, selected comorbidities, and medication habits, HZO patients were found to have a 4.52-fold (95% confidence interval 2.45-8.33) higher risk of stroke than the matched comparison cohort. There was no significant difference in the rate of stroke development between patients who had received systemic antiviral treatment and those who had not. Herpes zoster ophthalmicus may represent a marker of increased risk of stroke development during the 1-year follow-up period.

Role of polymerase chain reaction in early diagnosis of herpes zoster ophthalmicus in children

Herpes zoster ophthalmicus is uncommon in children, and diagnosis may be delayed until the typical skin lesions become apparent. Delay in appropriate treatment may result in sight-threatening complications. We report a case of an 18-month-old child in whom we promptly confirmed the clinical suspicion of herpes zoster ophthalmicus by the identification of viral DNA using polymerase chain reaction. This procedure enabled us to administer prompt antiviral treatment, preventing sight-threatening sequelae. We review the literature regarding the possible mechanism of herpes zoster ophthalmicus in immunocompetent children and discuss the role of polymerase chain reaction in its diagnosis.

Association of Herpes Zoster Ophthalmicus With Acquired Immunodeficiency Syndrome and Acute Retinal Necrosis

We conducted a review to investigate the prevalence of human immunodeficiency virus (HIV), or acquired immunodeficiency syndrome (AIDS), in patients with herpes zoster ophthalmicus, as well as the incidence of acute retinal necrosis after herpes zoster ophthalmicus. All charts of patients seen at our institution between 1987 and 1992 with a primary diagnosis of herpes zoster ophthalmicus were reviewed. Of 112 patients with herpes zoster ophthalmicus, 29 (26%) had HIV or AIDS. All these patients were younger than 50 years at the time of diagnosis. Five of 29 (17%) immunocompromised patients had acute retinal necrosis after herpes zoster ophthalmicus. No acute retinal necrosis was identified in the nonimmunocompromised patients after herpes zoster ophthalmicus. We recommend that all patients younger than 50 years who have herpes zoster ophthalmicus at initial examination be tested for HIV. Additionally, HIV-infected patients should be monitored closely after herpes zoster ophthalmicus for development of acute retinal necrosis. Long-term oral prophylactic as well as initial high-dose intravenous acyclovir may be appropriate in HIV-infected individuals with herpes zoster.

Herpes Zoster Optic Neuritis in Human Immunodeficiency Virus Infection

To the Editor. —Two individuals with presumed herpes zoster optic neuritis associated with human immunodeficiency virus (HIV) infection have been described to date. 1,2 One patient demonstrated improvement of visual acuity following intravenous acyclovir therapy. 1 Neither individual received systemic corticosteroids. We present a third patient with presumed varicella zoster optic neuritis in whom visual acuity rapidly deteriorated to no light perception despite aggressive intravenous acyclovir and corticosteroid treatment. Report of a Case. —A 40-year-old HIV-positive woman developed a vesicular eruption involving the ophthalmic division of the right trigeminal nerve accompanied by several small dendritic corneal lesions and an anterior uveitis of the right eye. Visual acuity was 20/40 OD and 20/20 OS. A diagnosis of herpes zoster ophthalmicus was made, and the patient underwent a 10-day course of intravenous acyclovir (4 g/d). During hospitalization, a thorough infectious evaluation was negative for other opportunistic infections associated with HIV infection, including cytomegalovirus,