Herpes Zoster Ophthalmicus Patients Research Articles

Risk Factors for the Development of Ocular Complications in Herpes Zoster Ophthalmicus and Zoster Vaccine Utilization in a Large, Urban Health System

To characterize the epidemiology of herpes zoster (HZ) and herpes zoster ophthalmicus (HZO) in an urban hospital system and determine risk factors associated with developing ocular complications in HZO. To report the frequency of shingles vaccination and HZ reactivation following shingles vaccination in this population. A retrospective cohort study was conducted on patients seen at the University of Illinois Hospital system from January 1, 2010 to December 1, 2021 with HZ and HZO identified by diagnosis code. Charts of HZO patients seen within 1 year of diagnosis were abstracted. Multivariable logistic regression analysis identified factors associated with the development of ocular complications in HZO. During the study period, 3283 patients had HZ; mean age of onset was 52.3 years, 61.6% were female, and 37% were Black. HZO with ocular involvement was seen in 110 (3.4%) patients. Ocular complications developed in 40 (36.4%) patients; the most common complication was corneal scarring (70%). Age (odds ratio [OR] 1.04, 95%CI 1.0-1.1), female gender (OR 2.86, 95%CI 1.0-8.1), steroids at initial visit (4.46, 95%CI 1.4-14.6), and stromal keratitis (OR 3.45, 95% CI 1.2, 9.8) were associated with developing ocular complications. Of eligible populations, 5333 (1.5%) received shingles vaccination; 43 patients developed reactivation of HZ following vaccination. In HZO, age, female gender, steroids at initial visit, and stromal keratitis are strongly associated with developing ocular complications. Shingles vaccination rates were low in this study population. Understanding potential for complications in HZ/HZO and vaccination uptake can help identify at risk populations to prevent disease. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Bilateral Pattern Electroretinogram Abnormalities in Patients with Herpes Zoster Keratitis and Conjunctivitis.

Herpes zoster ophthalmicus (HZO) results from the reactivation of varicella zoster virus (VZV) in the ophthalmic branch of the trigeminal nerve. The inflammation caused by VZV involves multiple tissues in the eyes. Our goal is to evaluate pattern electroretinogram (PERG) changes and their relationship with corneal sub-basal nerve changes in patients with HZO. Twenty-two patients with herpes zoster keratitis or conjunctivitis and 20 healthy volunteers were recruited for this cross-sectional study. A PERG test was performed on both eyes of HZO patients and one eye of the healthy controls. In vivo confocal microscopy (IVCM) was also performed on both eyes of the HZO patients to detect corneal nerve damage. Our results showed changes in the PERG parameters in both eyes of HZO patients compared to the healthy controls. Affected eyes showed delayed N95 peak time and decreased P50 and N95 amplitude compared to the unaffected eyes (p < 0.05, respectively). Both affected and unaffected eyes in HZO patients showed delayed P50 peak time and decreased N95 amplitude (p < 0.05, respectively) compared to controls. In HZO patients, no significant differences in each PERG parameter were found between eyes with and without corneal lesions or between eyes with and without increased Langham's cells in the corneal epithelial sub-basal layer. The IVCM images showed decreased total nerve length and number at the sub-basal layer of the epithelial cornea in affected eyes compared to unaffected eyes (p < 0.05). No significant correlation was found between total nerve length and PERG changes. Our results showed that VZV-affected eyes without central cornea involvement displayed reduced N95 amplitude and prolonged P50 peak time in bilateral eyes compared to the healthy controls. Larger studies are needed to further explore the effect of HZO on the electrophysiological response of the eye and the posterior segment.

Herpes Zoster Ophthalmicus Clinical Presentation and Risk Factors for Lesion Recovery.

Herpes zoster ophthalmicus (HZO) causes trouble in patients' daily life and work. In severe cases, it may even lead to a decrease or loss of vision. To understand the demographic information and ocular symptoms of hospitalized patients with HZO, and to find potential factors related to improvement time of skin rash and duration of ocular symptoms at discharge, we design this study. This is a retrospective study. All patients diagnosed with HZO who were hospitalized in the Department of Dermatology of a hospital in Chongqing, China from January 1, 2015 to December 30, 2021 were included in this study. A total of 189 patients were included in this study. Clinical manifestations of the disease during hospitalization, improvement time of ocular skin lesions, and whether ocular skin lesions disappeared completely at discharge were recorded. The most common ocular symptom was eyelid swelling (92.6%), followed by eye pain (48.7%). The most common ocular sign was conjunctivitis (78.3%), followed by keratitis (15.9%). There were 149 cases without residual ocular symptoms and 40 cases with residual ocular symptoms. There was no statistically significant difference in demographic characteristics between the two groups (P>0.05). Age ≥70 years (B=0.381, -0.061~0.022, P=0.005), use of glucocorticoids (B=0.260, 0.024~0.496, P=0.031), and use of topical antiviral drugs (B=0.380, 0.054~0.705, P=0.023) were factors affecting the time interval from admission to improvement of skin rash. Tearing (HR, OR=4.827, 1.956~11.909, P<0.001) and blood urea nitrogen (OR=0.787, 0.620-1.000, P=0.050) were factors influencing residual ocular symptoms. This study could help clinicians gain a deeper understanding of the clinical manifestations and partial influencing factors of HZO patients, which may contribute to future clinical work.

Ocular complications and factors affecting visual outcome in herpes zoster ophthalmicus: A prospective study in a tertiary care teaching hospital, Telangana, India

Background: Herpes zoster ophthalmicus (HZO) is caused by varicella zoster virus and affects the ocular branch of the trigeminal nerve. Aims and Objectives: To investigate the ocular complications and factors affecting visual prognosis in patients with HZO, a Varicella zoster virus infection affecting the ocular branch of the trigeminal nerve. Materials and Methods: 40 patients meeting the criteria were enrolled in the study, which was conducted at the Department of Ophthalmology, SVS Medical College, Mahbubnagar, Telangana, India. Results: The study found that more than 50% of HZO patients experienced ocular involvement, and acute corneal lesions, such as punctate and dendriform keratitis, uveitis, and severe post-herpetic discomfort, were associated with lower visual acuity. However, none of the patients in the study experienced posterior segment HZO problems such as acute retinal necrosis or progressive outer retinal necrosis. Older age groups were found to be more likely to experience post-herpetic neuralgia (PHN), which was also associated with nasociliary nerve involvement and vision loss. Conclusion: The study suggests early treatment with tricyclic antidepressants to aid in the early resolution of PHN. In addition, the study aimed to evaluate the effect of HIV/AIDS on ocular complications in HZO patients but did not report any findings in this regard.

In vivo confocal microscopy demonstrates longitudinal bilateral changes of corneal immune cells and nerves in herpetic keratitis

AbstractPurpose: To analyse bilateral corneal immune cell and nerve alterations in patients with unilateral herpes zoster ophthalmicus (HZO) by laser in vivo confocal microscopy (IVCM) and their correlation with corneal sensation and clinical findings.Materials and methods: This is a prospective, cross‐sectional, controlled, single‐center study. Twenty‐four eyes of 24 HZO patients and their contralateral clinically unaffected eyes and normal controls (n = 24) were included. Laser IVCM (Heidelberg Retina Tomograph/Rostock Cornea Module), corneal esthesiometry (Cochet‐Bonnet) were performed. Changes in corneal dendritiform cell (DC) density and morphology, number and length of subbasal nerve fibres and their correlation to corneal sensation, pain, lesion location, disease duration, and number of episodes were analysed.Results: HZO‐affected and contralateral eyes showed a significant increase in DC influx of the central cornea as compared to controls (147.4 ± 33.9, 120.1 ± 21.2, and 23.0 ± 3.6 cells/mm2; p &lt; 0.0001). In HZO eyes DCs were larger in area (319.4 ± 59.8 μm2; p &lt; 0.001) and number of dendrites (3.5 ± 0.4 n/cell; p = 0.01) as compared to controls (52.2 ± 11.7, and 2.3 ± 0.5). DC density and size showed moderate negative correlation with total nerve length (R = −0.43 and R = −0.57, respectively; all p &lt; 0.001). A higher frequency of nerve beading and activated DCs close to nerve fibres were detected specifically in pain patients.Conclusions: Chronic unilateral HZO causes significant bilateral increase in corneal DC density and decrease of the corneal subbasal nerves as compared to controls. Negative correlation was observed for DC density and size to nerve parameters, suggesting interplay between the immune and nervous systems. Patients with chronic pain also showed increased nerve beading and activated DCs.

The Prevalence of Ocular Manifestations in the Various Types of Common Skin Disorders at Tertiary Hospital in Ahmedabad, India.

AimThe article aims to study the prevalence and ocular manifestations of the various types of common skin disorders at a tertiary hospital in Ahmedabad, India. Materials and methodsFive hundred patients were studied in the ophthalmology department from September 2017 to September 2019.ResultsOut of the 500 patients that were included in our study, 312 were males, and 188 were females. In our study, lid involvement was seen most commonly in patients with herpes zoster ophthalmicus (HZO). Plexiform neurofibroma was seen in eight (14.5%) patients with neurofibromatosis (NF). Cicatricial ectropion was found in half of the patients with ichthyosis. Lagophthalmos was present in 10 (20.4%) patients with leprosy. Conjunctivitis was seen commonly in HZO patients. Papillary conjunctivitis was seen in half of the atopic dermatitis cases. Steven Johnson's syndrome (SJS) was associated with pseudomembranous conjunctivitis. Conjunctival xerosis was seen only in patients with Sjogren's syndrome. The cornea was most commonly involved in patients of HZO. Decreased corneal sensation was seen in leprosy and HZO. Lisch nodules were seen in NF cases. Anterior uveitis was found in seven (6.3%) patients with HZO. Glaucoma was seen most commonly in patients with Sturge Weber syndrome (SWS), followed by leprosy. Facial nerve palsy was seen in patients with leprosy. Episcleritis was seen in patients with leprosy and SWS.ConclusionWe conclude that ocular involvement in skin disease is a common feature and could be a major component of the development of various systemic skin disorders.

Ocular manifestation and visual outcomes in herpes zoster ophthalmicus: a prospective study from a tertiary hospital of Eastern India.

To estimate the magnitude of different ocular manifestation in clinically established herpes zoster ophthalmicus (HZO) patients and assessment of the visual outcome after two months of initial examination. An observational prospective study was conducted on 42 clinically diagnosed Tzanck smear positive cases HZO to observe the occurrence and frequency of different ocular manifestation and their visual outcome in 10-month period with 2mo follow up. Full ophthalmological examination using slit lamp, non-contact tonometry, applanation tonometry, direct and indirect ophthalmoscope were performed. Out of 42 patients of HZO, 33 had one or more type of ocular manifestation staring from lid skin involvement to conjunctivitis, keratitis, uveitis, increased intraocular pressure (IOP) and optic neuritis but no retinal manifestation. More number of HZO cases and ocular manifestation were found with advancement of ages. Young HZO patients were more associated with human immunodeficiency virus (HIV) infection and HIV infected people with HZO infection had more ocular manifestation. Male to female ratio was 2:1 among HZO cases but ocular manifestation occurred more among males. Female with advanced age were involved more. Lid involvement (73.81%), conjunctivitis (69.05%), and keratitis (59.52%) were most common ocular manifestation followed by anterior uveitis (30.95%) and episcleritis (11.90%). Ocular hypertension (42.86%) was associated with almost every ocular manifestation. Among the cases of more than 45 years of age, 9.52% patients acquired 6/6 vision compared to 7.14% patients at and below 45 years of age after 8wk of follow up. The visual outcomes are poor in HZO with advanced age group. Visual outcome of the affected eyes is poor than unaffected eyes. The loss of vision is mainly due to keratitis, anterior uveitis, posterior uveitis, and optic neuritis.

Bilateral Pupillary Involvement as a Clinical Presentation of Herpes Zoster Ophthalmicus

ABSTRACT Purpose Herpes zoster ophthalmicus (HZO) is traditionally considered as an unilateral disease. However, subclinical involvements in the contralateral eye structures are evidence, giving rise to a broader understanding of varicella-zoster virus (VZV) infection. Methods We enrolled 20 eyes of 10 patients with HZO and 12 eyes of healthy controls to investigate the bilateral features of HZO patients using a hand-held pupillometer and a Cochet-Bonnet esthesiometer. Results Maximum pupil size before constriction (INT) and minimum diameter when pupil constricts at peak (END) were significantly smaller in patients affected eyes compared with those in controls (p < .05). Interestingly, INT and END were significantly reduced in contralateral eyes of 20 affected patients and also in comparison to control group (p < .001 and p = .034 respectively). Conclusion The contralateral eyes may have subclinical involvement in patients with HZO based on significantly abnormal pupillary light reflex (PLR). Pupillometer provides a primary and convenient method to investigate the anatomy and pathology of the PLR

Chronic and Recurrent Herpes Zoster Ophthalmicus.

Background and Objectives: This study sought to investigate the natural course, the chronicity and recurrence rate, and the risk factors of chronic and recurrent herpes zoster ophthalmicus (HZO). We also evaluated the effects of long-term treatment for HZO. Materials and Methods: Patients diagnosed and treated for HZO were included in the retrospective medical chart review. Multivariable-adjusted logistic and Cox regression models were used to show risk factors for chronic and recurrent HZO along with hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Among a total 130 of HZO patients, 31 patients (23.85%) had chronic disease and 19 patients (14.62%) had recurrent disease. The rate of chronic disease was higher in HZO with conjunctivitis, epithelial keratitis, and stromal keratitis. The recurrence rate increased in patients with chronic HZO (HR: 34.4, 95% CI: 3.6–324.6), epithelial keratitis (HR: 5.5, 95% CI: 1.3–30.0), stromal keratitis (HR: 18.8, 95% CI: 3.0–120.8), and increased intraocular pressure (IOP) (HR: 7.3, 95% CI: 1.6–33.2). Length of systemic antiviral therapy and anti-inflammatory eyedrop treatment were not associated with recurrent HZO (p = 0.847 and p = 0.660, respectively). The most common ocular manifestation for recurrent HZO was stromal keratitis. Conclusions: This study demonstrated a considerable frequency of chronic and recurrent HZO. Chronic HZO in the form of epithelial or stromal keratitis with increased IOP provoked a significant rise in the risk of recurrence.

Enrollment in the Zoster Eye Disease Study.

To present the results of a survey of the Zoster Eye Disease Study (ZEDS) investigators regarding barriers to the enrollment of study participants and approaches to overcome them. ZEDS is a multicenter randomized clinical trial supported by the National Eye Institute to determine whether prolonged suppressive valacyclovir reduces the complications of herpes zoster ophthalmicus (HZO), relative to placebo. Enrollment of study participants is currently far below expectations. An institutional review board-approved anonymous internet survey was conducted of ZEDS investigators to study their experiences and opinions regarding barriers to enrollment and various approaches to overcome them. The overall survey response rate was 54% (79/145). Only 29% (23/79) agreed that it is easy to enroll study participants. Regarding patient barriers, 69% (55/79) agreed that HZO patients want to be treated with antiviral medication and 69% (54/78) agreed that HZO patients on antivirals do not want to be randomized. Regarding personal barriers facing investigators, 91% (72/79) agreed that antivirals are effective and 100% that the research questions ZEDS is designed to answer are very important. Fewer than 30% of respondents believed that steps taken to increase enrollment have been very helpful. Over half (54%, 42/78) believed that advertising on social media would be moderately or very effective. Belief among ZEDS investigators that antivirals are effective, and the preference of patients to be treated with antivirals rather than be randomized in ZEDS, are major barriers to enrollment. New approaches to overcoming barriers are necessary to develop an evidence-based standard of care for treatment of HZO.

Herpes zoster ophthalmicus: clinicodemographic characteristics and outcomes of 64 Egyptian patients

Background Herpes zoster ophthalmicus (HZO) accounts for 10–20% of all patients with herpes zoster. Objectives This study aimed to evaluate demographic features, clinical presentations, and outcomes of HZO patients. Patients and methods In a prospective cross-sectional clinical study, it included 64 patients with clinically evident HZO. All patients underwent a detailed medical history and complete dermatological and ophthalmological examinations. Results This study included 64 patients with HZO; 41 (64.1%) were females and 23 (35.9%) were males. Of female patients with HZO, 30 (73.2%) were married, 20 (48.7%) were urban, 35 (85.4%) were housewives, 17 (41.4%) had medium socioeconomic levels, 41 (100%) were nonsmokers, 13 (31.70%) had diabetes mellitus, six (14.63%) had hypertension, 30 (73.2%) had eruption on the left side, 11 (26.8%) had conjunctivitis and lid edema, 13 (31.7%) had postherpetic neuralgia, 29 (70.7%) had posttreatment scars, and six (14.6%) had a reduced visual outcome. Of male patients with HZO, 20 (87%) were married, 12 (52.2%) were suburban, seven (30.4%) were worker, 14 (60.9%) had low socioeconomic levels, 15 (65.2%) were smokers, eight (34.8%) had diabetes mellitus, one (4.3%) had hypertension, 18 (78.3%) had eruption on the left side, nine (39.16%) had conjunctivitis and lid edema, seven (30.4%) had postherpetic neuralgia, 10 (43.5%) had post-HZO cutaneous scarring, and four (17.4%) had a reduced visual outcome. Limitations The sample size of this study was small. Conclusion This study concluded that HZO is a common and potentially ruinous disease that may show a significant ophthalmic morbidity if not adequately diagnosed and treated.

Symptoms and complications of Herpes Zoster Ophthalmicus in Patients Admitted to Ayatollah Rouhani Hospital in Babol

Symptoms and complications of Herpes Zoster Ophthalmicus in Patients Admitted to Ayatollah Rouhani Hospital in Babol

Increased risk of dementia following herpes zoster ophthalmicus.

This retrospective cohort study aimed to examine the relationship between herpes zoster ophthalmicus (HZO) and the subsequent risk of dementia using a population-based database. We retrieved the study sample from the Taiwan Longitudinal Health Insurance Database 2005. The study group included 846 patients with HZO, and the comparison group included 2538 patients without HZO. Each patient was individually followed for a 5-year period to identify those patients who subsequently received a diagnosis of dementia. We performed a Cox proportional hazards regression to calculate the hazard ratios (HRs) along with 95% confidence intervals (CIs) for dementia during the follow-up period between patients with HZO and comparison patients. The respective incidence rates of dementia per 1000 person-years were 10.15 (95% CI: 7.22~13.87) and 3.61 (95% CI: 2.61~4.89) for patients with HZO and comparison patients. The Cox proportional analysis showed that the crude HR of dementia during the 5-year follow-up period was 2.83 (95% CI: 1.83–4.37) for patients with HZO than comparison patients. After adjusting for patients’ characteristics and comorbidities, HZO patients were still at a 2.97-fold greater risk than comparison patients for developing dementia. Furthermore, we found that of sampled male patients, the crude HR of dementia for patients with HZO was as high as 3.35 (95% CI = 1.79–6.28) compared to comparison patients. This study demonstrated an association between HZO and dementia. Clinicians must be alert to suspect dementia in patients with cognitive impairment who had prior HZO.

In vivo confocal microscopy detects bilateral changes of corneal immune cells and nerves in unilateral herpes zoster ophthalmicus

PurposeTo analyze bilateral corneal immune cell and nerve alterations in patients with unilateral herpes zoster ophthalmicus (HZO) by laser in vivo confocal microscopy (IVCM) and their correlation with corneal sensation and clinical findings. Materials and methodsThis is a prospective, cross-sectional, controlled, single-center study. Twenty-four eyes of 24 HZO patients and their contralateral clinically unaffected eyes and normal controls (n = 24) were included. Laser IVCM (Heidelberg Retina Tomograph/Rostock Cornea Module), corneal esthesiometry (Cochet-Bonnet) were performed. Changes in corneal dendritiform cell (DC) density and morphology, number and length of subbasal nerve fibers and their correlation to corneal sensation, pain, lesion location, disease duration, and number of episodes were analyzed. ResultsHZO-affected and contralateral eyes showed a significant increase in DC influx of the central cornea as compared to controls (147.4 ± 33.9, 120.1 ± 21.2, and 23.0 ± 3.6 cells/mm2; p < 0.0001). In HZO eyes DCs were larger in area (319.4 ± 59.8 μm2; p < 0.001) and number of dendrites (3.5 ± 0.4 n/cell; p = 0.01) as compared to controls (52.2 ± 11.7, and 2.3 ± 0.5). DC density and size showed moderate negative correlation with total nerve length (R = −0.43 and R = −0.57, respectively; all p < 0.001). A higher frequency of nerve beading and activated DCs close to nerve fibers were detected specifically in pain patients. ConclusionsChronic unilateral HZO causes significant bilateral increase in corneal DC density and decrease of the corneal subbasal nerves as compared to controls. Negative correlation was observed for DC density and size to nerve parameters, suggesting interplay between the immune and nervous systems. Patients with chronic pain also showed increased nerve beading and activated DCs.

Correlating CD4 count with mucocutaneous manifestations in HIV-positive patients: A prospective study.

Background:Mucocutaneous findings may be the presenting symptoms in HIV-afflicted individuals. A multitude of mucocutaneous diseases also occurs during the course of the ailment, with some conditions being classed as disease defining. They include infectious diseases and noninfective inflammatory and neoplastic dermatoses. With progressive fall in CD4 count, there is a change in the types of mucocutaneous lesions encountered.Aim:This study aims to statistically correlate the CD4 counts with the mucocutaneous manifestations in 100 HIV-positive patients.Materials and Methods:A total of 100 cases of HIV-positive patients with skin and mucous membrane manifestations were selected serially. A complete history was taken, clinical examination was done, and the CD4 count was noted. Patients were divided into four groups (Groups I, II, III, IV) with different ranges of CD4 values, namely, <50, 50–200, 201–500, >500, respectively.Results:The distribution of study population in CD4 ranges showed that majority (47%) of the study population had CD4 count between 201 and 500, and 29% of the study group had CD4 count between 50 and 200 cells. Almost 21% of the patients had the count > 500 cells and 3% had cell count < 50. Majority of the infectious and non-infectious dermatoses were common in the CD4 count between 201–500 (Group III) and 50–200 (Group II). In the study groups, 52 cases (52%) were on antiretroviral therapy (ART), and the remaining 48 cases (48%) were not on ART at the time of diagnosis of mucocutaneous manifestations. Out of 48 ART-naïve cases, 23 patients were screened and newly diagnosed at the outpatient department (OPD) based on the mucocutaneous manifestations. Most of the patients with multiple mucocutaneous conditions were in the CD4 count <200, whereas single manifestation was seen predominantly in CD4 count >200.Conclusion:Statistically significant association with the CD4 count was seen in herpes zoster ophthalmicus, genital wart, genital herpes, vaginal discharge syndrome, scabies, pyoderma, dermatophytosis, Hansen's disease, herpetic gingivostomatitis, seborrhoeic dermatitis, lichen planus, and drug reactions. These dermatoses may indicate the worsening of immune status and the need for regular monitoring with periodical CD4 counting. Occurrence of dermatoses such as photosensitive eczema, drug reaction, lichen planus, Type I lepra reaction, and herpes zoster ophthalmicus in patients on ART may be due to IRIS. To avoid the more frequent occurrence of infectious dermatoses and to reduce the development of IRIS with ART, all HIV-positive cases may be started on ART at higher CD4 count. Screening for HIV infection is suggested whenever the following conditions are seen: persistent oral candidiasis, atypical manifestations of zoster, herpes zoster ophthalmicus, herpetic gingivostomatitis and MC in adults, exaggerated IBA, and extensive seborrhoeic dermatitis.

Multiple Serous Chorioretinopathy after Facial Herpes Zoster

Purpose: To report a case of multiple serous chorioretinopathy after facial herpes zoster. Case summary: A 48-year-old male visited our clinic due to visual disturbance in the left eye which occurred 3 days after left facial pain and vesicles. Chemosis and multiple serous retinal detachments were found. The patient was diagnosed with multiple serous chorioretinopathy due to herpes zoster virus and was started on intravenous acyclovir at a dose of 10 mg/kg every 8 hours for 9 days and herpes eye ointment 5 times daily. After the initial treatment, oral prednisolone 60 mg was given daily for 6 days. Skin lesions were cleared, and abnormal fundus and visual acuity improved after treatment. Conclusions: Ophthalmopathy including multiple serous chorioretinopathy should be considered in managing herpes zoster ophthalmicus patients. J Korean Ophthalmol Soc 2016;57(1):150-154

Early- and late-stage ocular complications of herpes zoster ophthalmicus in rural South Africa.

To describe the spectrum of ocular complications of herpes zoster ophthalmicus (HZO) in rural South Africa. Patients presenting with visual complaints and active or healed HZO at the ophthalmology outpatient department of three hospitals in rural South Africa were included in this study. Demographic and clinical data were collected, and HIV status was determined for all participants. Forty-eight patients were included, and 81% were HIV infected. Poor vision was reported by 94% of patients, painful eye by 79% and photophobia by 63%. A diverse spectrum of ocular complications was observed with corneal inflammation and opacification in 77% followed by anterior uveitis in 65%. The majority (65%) presented with late-stage ocular complications associated with irreversible loss of vision whereas early-stage complications, such as punctate epithelial keratitis and anterior uveitis, were less common. Blindness of the affected eye was observed in 68% of patients with late-stage complications. There was a considerable delay between onset of symptoms and first presentation to the ophthalmology outpatient department (median time 35days; range 1-2500days), and longer delay was associated with late-stage ocular complications (P=0.02). HZO patients present with relatively late-stage ocular complications, and blindness among these patients is common. The delayed presentation to the ophthalmology outpatient department of hospitals in our rural setting is of concern, and efforts to improve ocular outcomes of HZO are urgently needed.

Acute pain management of senile patients with herpes zoster ophthalmicus combined with diabetes mellitus

Objective To explore acute pain management of senile patients with herpes zoster ophthalmicus combined with diabetes mellitus. Methods From 2010 January to 2012 June, 108 cases of elderly herpes zoster ophthalmicus patients combined with diabetes were randomly divided into control group and experimental group, each of 54 cases.Patients in control group received traditional nursing, in the observation group, strengthening initiative to implement effective management of pain in acute stage, early accurate pain assessment, effective drugs or physical analgesic therapy. Results Analgesic treatment attitude, acute perioperative analgesic therapy frequency and pain treatment satisfaction in the observation group were better than those in the control group; The differences were statistically significant in postherpetic neuralgia and hospitalization time(P< 0.05). Conclusions Effective pain management for senile patients with herpes zoster ophthalmicus combined with diabetes mellitus can relieve pain, reduce complications such as postherpetic neuralgia, shorten the state of illness, improve the quality of life of patients. Key words: Herpes zoster ophthalmicus; Acute phase; Pain management; Diabetes mellitus

Ocular involvement and visual outcome of herpes zoster ophthalmicus: review of 45 patients from Tunisia, North Africa.

BackgroundOcular complications of herpes zoster ophthalmicus (HZO) may lead to substantial visual impairment. The purpose of this study was to characterize and analyze ocular involvement and visual outcome of HZO in patients from Tunisia, North Africa. This study is a retrospective chart review of 51 eyes of 45 patients with HZO.ResultsMean age was 44.5 years. Thirty patients (66.7%) were aged over 50 years. Twenty-four patients (53.3%) were male and 21 patients were female (46.7%). There was no statistically significant difference in gender distribution. Initial mean best corrected visual acuity (BCVA) was 20/50. Ocular manifestations included adnexal involvement (58.8%), keratitis (31.4%), keratouveitis (31.4%), isolated anterior uveitis (AU) (29.4%), intraocular pressure elevation (23.5%), oculomotor nerve palsy (5.8%), and optic neuritis (1.9%). Isolated AU (p < 0.001), isolated keratitis (p = 0.001), and intraocular pressure elevation (p = 0.013) were more likely to be concomitant to HZO active skin disease, while keratouveitis occurred more likely more than 1 month after HZO eruption (p < 0.001). AU and keratouveitis were more likely to be associated with age ≥ 50 years (p = 0.001 and p = 0.02, respectively). Ocular complications included neurotrophic keratopathy (1.9%), corneal opacity (5.9%), secondary glaucoma (7.8%), optic atrophy (1.9%), and postherpetic neuralgia (13.3%). Mean follow-up was 12 months. Mean final BCVA was 20/32; it was ≥ 20/40 in 78.4% of the eyes.ConclusionsOur study provided epidemiologic and clinical data of HZO in a Tunisian population. AU and keratitis were the most common ocular complications. Neurotrophic keratopathy was scarce. The overall visual outcome is good, with about three quarters of the treated patients maintaining VA of 20/40 or better.

Physician survey for study of suppressive antiviral treatment to reduce chronic ocular disease and postherpetic neuralgia after herpes zoster ophthalmicus.

The purpose of this study was to develop a consensus regarding the appropriate regimen to evaluate long-term suppressive antiviral treatment to reduce complications from herpes zoster ophthalmicus (HZO) and identify potential study sites. In January 2013, a survey of 13 questions was distributed among cornea fellowship directors, board members of the Cornea Society and Ocular Microbiology and Immunology Group, and Kera-net Listserv members. Questions identified respondents' preferred antiviral regimens to administer for chronic or recurrent HZO, gauged the level of interest in participation in a planned randomized clinical trial, and assessed the number of HZO patients treated among specialists in the past year. Of the 171 respondents who completed the questionnaire, the majority identified as Kera-net Listserv members (107 of 171, 63%) and cornea fellowship directors (46 of 171, 27%). First choice of treatment was valacyclovir 500 mg 2 times per day (61 of 171, 36%), followed by acyclovir 800 mg 2 times per day (56 of 171, 33%), and then valacyclovir 1,000 mg daily (26.9%, 46 of 171). Among the choices, famciclovir consistently placed last among all the respondents (7 of 171, 4%). A majority (106 of 171, 62%) of all respondents, including 70% (26 of 37) of U. S. respondents of the high-volume practices, were interested in participating in a future randomized clinical trial evaluating whether treatment with oral antiviral medications for 1 year decreases complications of HZO. This survey highlights the strong interest in and support for further study of suppressive antiviral treatment regimens to reduce complications of HZO.