From the Guidelines
Herpes zoster in the eye is called herpes zoster ophthalmicus (HZO). This condition occurs when the varicella-zoster virus, which causes chickenpox and shingles, reactivates in the ophthalmic branch of the trigeminal nerve. HZO typically presents with a painful rash on the forehead, upper eyelid, and sometimes the tip of the nose (Hutchinson's sign), along with eye symptoms such as redness, pain, light sensitivity, and blurred vision.
Key Points
- The incidence of varicella (herpes) zoster virus is reduced by the chickenpox and the shingles vaccines, as stated in the study by 1.
- Treatment usually involves antiviral medications like acyclovir (800 mg five times daily), valacyclovir (1000 mg three times daily), or famciclovir (500 mg three times daily) for 7-10 days, started within 72 hours of rash onset for best results.
- Topical steroids may be prescribed for inflammatory complications, but only under ophthalmological supervision, as mentioned in the study by 1.
- Pain management with analgesics is also important.
- Prompt treatment is essential as HZO can lead to serious complications including corneal scarring, glaucoma, and vision loss if not properly managed.
- Patients with eye involvement should be referred to an ophthalmologist immediately for specialized care.
Prevention
- Ophthalmologists and other health care professionals should strongly recommend immunocompetent patients 50 years or older without contraindications to obtain vaccination against herpes zoster, as recommended in the study by 1.
- The recombinant zoster vaccine (RZV) is preferred over ZVL for the prevention of herpes zoster and related complications, as stated in the study by 1.
From the Research
Definition of Herpes Zoster in the Eye
Characteristics of Herpes Zoster Ophthalmicus
- HZO is a subset of Herpes Zoster (HZ) with involvement of the ophthalmic division of the fifth cranial trigeminal nerve 3, 5.
- It is considered an ophthalmic emergency due to the wide range of associated ocular symptoms, including severe chronic pain and vision loss 5.
- HZO commonly affects older and immunocompromised patients 3, 5.
Treatment and Prevention of Herpes Zoster Ophthalmicus
- Timely treatment with antivirals is recommended to prevent ocular complications 2, 3, 4.
- Vaccination against Herpes Zoster is also recommended to prevent HZO 3, 4.
- Both the recombinant adjuvanted vaccine (RZV) and live-attenuated vaccine (ZVL) significantly reduce the incidence of HZ and HZO in older adults 3.