What is the prognosis and treatment for herpes zoster (shingles) eye involvement?

From the Guidelines

Herpes zoster eye involvement requires prompt treatment with oral antiviral therapy, such as acyclovir (800mg five times daily) for 7-10 days, to prevent vision loss and reduce complications, as recommended by the CDC guidelines 1. The prognosis of herpes zoster eye involvement varies based on the specific ocular structures involved, with corneal involvement potentially causing permanent scarring and vision loss.

• Key factors influencing prognosis include:
  • The severity of the infection
  • The presence of underlying immunosuppression
  • The promptness and effectiveness of treatment
  • The involvement of specific ocular structures, such as the cornea or retina
• Complications of herpes zoster eye involvement can be severe and include:
  • Chronic pain (postherpetic neuralgia)
  • Corneal scarring
  • Glaucoma
  • Cataracts
  • Retinal damage Regular follow-up with an ophthalmologist is essential, as some complications may develop weeks to months after the initial infection.
• Prevention of herpes zoster through vaccination is also crucial, with the recombinant zoster vaccine (RZV) being preferred over the live zoster vaccine (ZVL) for adults 50 years and older, as recommended by the CDC Advisory Committee on Immunization Practices 1. Early treatment and prevention strategies can significantly improve outcomes by reducing viral replication and subsequent inflammation that causes tissue damage.
• Patients should be advised to:
  • Avoid touching the affected eye
  • Use separate towels to prevent viral spread
  • Practice good hygiene to prevent the spread of the virus to others.

From the FDA Drug Label

The times to full crusting, loss of vesicles, loss of ulcers, and loss of crusts were shorter for famciclovir 500 mg-treated patients than for placebo-treated patients in the overall study population. In the 186 patients (44. 4% of total study population) who developed postherpetic neuralgia, the median duration of postherpetic neuralgia was shorter in patients treated with famciclovir 500 mg than in those treated with placebo (63 days and 119 days, respectively).

The prognosis and treatment for herpes zoster (shingles) eye involvement is not directly addressed in the provided drug label. However, the label does discuss the treatment of herpes zoster with famciclovir, which may be relevant to eye involvement.

• Key points:
  • Famciclovir 500 mg three times daily can reduce the time to full crusting and loss of vesicles, ulcers, and crusts.
  • The median duration of postherpetic neuralgia was shorter in patients treated with famciclovir 500 mg than in those treated with placebo.
• Clinical decision: The provided information does not directly answer the question about the prognosis and treatment of herpes zoster eye involvement. Therefore, no conclusion can be drawn from this data alone 2.

From the Research

Herpes Zoster Eye Involvement Prognosis

The prognosis for herpes zoster eye involvement, also known as herpes zoster ophthalmicus (HZO), varies depending on several factors, including the severity of the infection and the promptness of treatment.

• According to 3, HZO can affect all ophthalmic structures and may lead to severe eye-threatening complications such as panuveitis, acute retinal necrosis (ARN), and progressive outer retinal necrosis (PORN).
• A study by 4 found that mild to moderate visual loss occurred in 23% of patients at 1 month, 14% at 2 months, and 10% at 6 months follow-up, but none of the patients developed visual loss with a corrected VA of less than 0.3.
• Another study by 5 reported a case of complete ophthalmoplegia following herpes zoster, which is a very rare condition, and the prognosis is very good with almost complete remission of the symptoms within 18 months.

Treatment for Herpes Zoster Eye Involvement

The primary treatment for HZO is antiviral medication, which is most effective when started within 72 hours after the onset of the rash.

• As stated in 3, antiviral medications remain the primary therapy, mainly useful in preventing ocular involvement when begun within 72 hours after the onset of the rash.
• According to 6, the drugs approved in Europe for the systemic treatment of herpes zoster are aciclovir, valaciclovir, famciclovir, and brivudine, and the treatment should be combined with analgesics and neuroactive agents to reduce pain.
• A case series and literature review by 7 highlighted the importance of early recognition and management of orbital apex syndrome complicating HZO, and all patients received systemic steroid and antiviral therapy, but a standardized dosage and duration of treatment remains to be defined.