From the Guidelines
Herpes zoster ophthalmicus is a medical emergency that requires immediate attention, as it can cause permanent vision damage or blindness if not treated promptly. The condition can lead to severe conjunctival scarring from secondary bacterial infection, cicatricial ectropion, and other ocular diseases such as pseudodendrites, keratitis, corneal scarring, corneal vascularization, iritis/uveitis, sectoral iris atrophy, and secondary glaucoma 1.
Key Considerations
- Herpes zoster ophthalmicus can cause significant morbidity and impact quality of life if not treated promptly and effectively.
- Treatment typically includes antiviral medications like acyclovir (800mg five times daily), valacyclovir (1000mg every 8 hours), or famciclovir (500mg three times daily) for 7 days, as recommended in the conjunctivitis preferred practice pattern 1.
- These medications are most effective when started within 72 hours of rash appearance, highlighting the need for urgent medical attention.
- Patients with chronic disease may require prolonged treatment with adjustment of the dose according to the clinical response, and those with impaired renal clearance should be treated with caution 1.
Warning Signs and Symptoms
- Eye pain, redness, light sensitivity, blurred vision, or a rash on the forehead, nose, or around the eye are warning signs that require immediate medical attention.
- Patients who experience these symptoms should seek emergency care or see an ophthalmologist within 24 hours to prevent long-term vision damage or blindness.
- The use of over-the-counter eye drops without medical advice is not recommended, as it can exacerbate the condition or delay proper treatment.
From the Research
Herpes Zoster Ophthalmicus as an Emergency
- Herpes zoster ophthalmicus (HZO) is a serious condition that requires prompt medical attention, as it can lead to permanent vision loss if left untreated 2, 3.
- The condition is characterized by the reactivation of the varicella-zoster virus in the ophthalmic division of the trigeminal nerve, resulting in ocular complications such as conjunctivitis, keratitis, and uveitis 3.
- Early recognition and timely treatment with antivirals are crucial in preventing ocular complications and reducing the risk of vision impairment 4, 3.
Importance of Urgent Ophthalmic Consultation
- Due to the potential for vision impairment, ocular involvement in HZO requires urgent ophthalmic consultation 3.
- Delayed treatment can lead to chronic or recurrent disease, with up to 25% of patients developing long-term ocular complications 3.
- Antiviral medications, such as valaciclovir and famciclovir, have been shown to be effective in reducing the risk of pain and ocular complications in patients with HZO 4, 5.
Prevention and Treatment
- Vaccination against herpes zoster is an effective way to prevent HZO, with both the recombinant adjuvanted vaccine (RZV) and live-attenuated vaccine (ZVL) significantly reducing the incidence of HZ and HZO in older adults 3.
- Oral and topical antiviral medications can play a role in managing the acute disease, and early treatment can help reduce the risk of ocular complications 6, 5.