eMedicine Specialties > Ophthalmology > Infectious Disease

Herpes Zoster: Follow-up

Author: Manolette R Roque, MD, MBA, President and CEO, Service Chief of Ocular Immunology and Uveitis, Refractive Surgery, EYE REPUBLIC Ophthalmology Clinic; General Manager, Ophthalmic Consultants Philippines; Section Chief of Ocular Immunology and Uveitis, Department of Ophthalmology, Asian Hospital and Medical Center; Section Chief of Ocular Immunology and Uveitis, Department of Ophthalmology, St. Luke's Medical Center Global City; Senior Eye Surgeon, The LASIK Surgery Clinic
Coauthor(s): Barbara L Roque, MD, Full Partner, Ophthalmic Consultants Philippines Co, Chief of Service, Pediatric Ophthalmology and Strabismus, Consulting Staff, Orbit and Eye Plastics, Eye Republic Ophthalmology Clinic; C Stephen Foster, MD, FACS, FACR, FAAO, Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; Founder and President, Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institution
Contributor Information and Disclosures

Updated: Oct 28, 2008

Follow-up

Further Inpatient Care

  • Hospital admission should be considered for any of the following situations: severe symptoms, immunosuppression, and more than 2 dermatomal involvements.
  • Wet to dry dressings with sterile saline solution or Burow's solution (pharmacological preparation made of 5% aluminum acetate dissolved in water) should be applied to the affected skin for 30-60 minutes 4-6 times per day.
  • Calamine lotion, a mixture of zinc oxide (ZnO) with about 0.5% iron(III) oxide (Fe2 O3), may be used as an antipruritic (anti-itching) agent. It is also used as a mild antiseptic to prevent infections that can be caused by scratching the affected area, as well as an astringent for dry weeping or oozing blisters. There is no proof that calamine has any real therapeutic effect on rashes and itching.


Further Outpatient Care

  • Follow-up care in a pain clinic may be advised.
  • Continued counseling care with a psychiatrist may be warranted in some situations.

Inpatient & Outpatient Medications

Deterrence/Prevention

Complications

  • Pavan-Langston reviewed complications of untreated herpes zoster ophthalmicus and noted the following:
    • Severe acute pain (90%)
    • Infectious, scarring rash (85%)
    • Conjunctivitis, episcleritis, and scleritis (75%)
    • Lid distortion (70%)
    • Infectious and/or immune keratitis (55%)
    • Uveitis (45%)
    • PHN, 20-60% (age <40-60 y)
    • Glaucoma and/or cataract (10%)
    • Neuro-ophthalmic (8%)
  • Liesegang presented a series of 86 consecutive patients with complications from herpes zoster ophthalmicus, which included the following:
    • Lid complications (ie, ptosis, hemorrhagic necrosis, ectropion, scarring)
    • Canalicular occlusion
    • Keratitis
    • Scleritis or episcleritis
    • Iridocyclitis
    • Glaucoma (ie, secondary)
    • Cataract
    • Neuro-ophthalmic
    • Postherpetic neuralgia
  • Foster and Sainz de la Maza's review of 172 cases of scleritis included a case secondary to herpes zoster.21 Another case resulted in herpes zoster episcleritis. However, immune-mediated diseases are the main disorders associated with scleritis.
  • Ramsay Hunt syndrome (geniculate zoster) occurs with herpetic infection of the geniculate ganglion. In addition to facial paresis, a herpetic eruption may be found either in the external auditory canal, the pinna, or the palate.
  • Bell palsy is the most common lower motor neuron facial paresis. VZV has been implicated in its pathogenesis.
  • Herpes zoster ophthalmicus with delayed contralateral hemiplegia has been reported.

Prognosis

  • Of 1 million individuals examined each year for herpes zoster, 250,000 develop herpes zoster ophthalmicus.
  • About 50% of patients with herpes zoster ophthalmicus develop complications.89,90

Patient Education

  • Herpes zoster should be properly identified as early as possible. Patients should consult a physician immediately after the rash erupts.
  • For excellent patient education resources, visit eMedicine's Bacterial and Viral Infections Center. Also, see eMedicine's patient education articles Chickenpox and Shingles.

Miscellaneous

Medicolegal Pitfalls

  • The risk of herpes zoster is increased among persons infected with HIV.
  • HIV infection should be considered in any patient with herpes zoster who is younger than 45 years or who is in a recognized risk group for AIDS.

Special Concerns

  • Geriatric individuals: The natural declining immunity with age is believed to allow the reactivation of VZV in the sensory ganglia.
  • Immunocompromised individuals
    • This population includes immunosuppressed organ-transplant recipients and immune-deficient patients with cancer, leukemia, and AIDS. These patients are at increased risk of acquiring the infection.
    • Herpes zoster is more likely to be severe and prolonged and to lead to dissemination (>20 vesicles outside the primary and immediately adjacent dermatome) in this population than in others.
    • Dissemination implies a viremia, which may lead to visceral (eg, lungs, liver, brain) or neurologic (eg, motor neuropathies of the cranial and peripheral nervous system, encephalitis, meningoencephalitis, myelitis, Guillain-Barré syndrome) infection.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the assistance of Ryan I Huffman, MD, with the literature review and referencing for this article.



More on Herpes Zoster

Overview: Herpes Zoster
Differential Diagnoses & Workup: Herpes Zoster
Treatment & Medication: Herpes Zoster
Follow-up: Herpes Zoster
Multimedia: Herpes Zoster
References
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References

  1. Chern KC, Margolis TP. Varicella zoster virus ocular disease. Int Ophthalmol Clin. Fall 1998;38(4):149-60. [Medline].

  2. Kuo YH, Yip Y, Chen SN. Retinal vasculitis associated with chickenpox. Am J Ophthalmol. Oct 2001;132(4):584-5. [Medline].

  3. Ang LP, Au Eong KG, Ong SG. Herpes zoster ophthalmicus. J Pediatr Ophthalmol Strabismus. May-Jun 2001;38(3):174-6. [Medline].

  4. Cockburn DM, Douglas IS. Herpes zoster opthalmicus. Clin Exp Optom. Mar-Apr 2000;83(2):59-64. [Medline].

  5. Gurwood AS, Savochka J, Sirgany BJ. Herpes zoster ophthalmicus. Optometry. May 2002;73(5):295-302. [Medline].

  6. Karbassi M, Raizman MB, Schuman JS. Herpes zoster ophthalmicus. Surv Ophthalmol. May-Jun 1992;36(6):395-410. [Medline].

  7. Marsh RJ, Cooper M. Ophthalmic herpes zoster. Eye. 1993;7 (Pt 3):350-70. [Medline].

  8. Syal R, Tyagi I, Goyal A. Bilateral Ramsay Hunt syndrome in a diabetic patient. BMC Ear Nose Throat Disord. Dec 2 2004;4(1):3. [Medline].

  9. Verhulst E, Van Lammeren M, Dralands L. Diplopia from skew deviation in Ramsey-Hunt syndrome. A case report. Bull Soc Belge Ophtalmol. 2000;27-32. [Medline].

  10. Ritterband DC, Friedberg DN. Virus infections of the eye. Rev Med Virol. Oct 1998;8(4):187-201. [Medline].

  11. Ongkosuwito JV, Feron EJ, van Doornik CE, et al. Analysis of immunoregulatory cytokines in ocular fluid samples from patients with uveitis. Invest Ophthalmol Vis Sci. Dec 1998;39(13):2659-65. [Medline].

  12. Kumano Y, Manabe J, Hamamoto M, et al. Detection of varicella-zoster virus genome having a PstI site in the ocular sample from a patient with acute retinal necrosis. Ophthalmic Res. 1995;27(5):310-6. [Medline].

  13. Karlin JD. Herpes zoster ophthalmicus: the virus strikes back. Ann Ophthalmol. Jun 1993;25(6):208-15. [Medline].

  14. Liesegang TJ. Herpes zoster ophthalmicus natural history, risk factors, clinical presentation, and morbidity. Ophthalmology. Feb 2008;115(2 Suppl):S3-12. [Medline].

  15. Liesegang TJ. Varicella-zoster virus eye disease. Cornea. Sep 1999;18(5):511-31. [Medline].

  16. Franco-Paredes C, Bellehemeur T, Merchant A, et al. Aseptic meningitis and optic neuritis preceding varicella-zoster progressive outer retinal necrosis in a patient with AIDS. AIDS. May 3 2002;16(7):1045-9. [Medline].

  17. Ahn M, Cho NC. Central retinal artery occlusion in herpes zoster ophthalmicus. J Pediatr Ophthalmol Strabismus. Mar-Apr 2002;39(2):123-4. [Medline].

  18. Akpek EK, Gottsch JD. Herpes zoster sine herpete presenting with hyphema. Ocul Immunol Inflamm. Jun 2000;8(2):115-8. [Medline].

  19. Berry-Brincat A, Von Lany H, Evans N. Scleromalacia as a complication of herpes zoster ophthalmicus. Eye. Apr 2003;17(3):449-51. [Medline].

  20. Cunningham ET. Diagnosing and treating herpetic anterior uveitis. Ophthalmology. Dec 2000;107(12):2129-30. [Medline].

  21. Foster CS, Sainz de la Maza M. The Sclera. New York, NY: Springer-Verlag; 1994.

  22. Meenken C, van den Horn GJ, de Smet MD, et al. Optic neuritis heralding varicella zoster virus retinitis in a patient with acquired immunodeficiency syndrome. Ann Neurol. Apr 1998;43(4):534-6. [Medline].

  23. Mearza AA, Chan JH, Gair E, et al. Herpes zoster ophthalmicus presenting as contralateral disc swelling. Eye. Apr 2000;14 (Pt 2):251-2. [Medline].

  24. Siverio Junior CD, Imai Y, Cunningham ET Jr. Diagnosis and management of herpetic anterior uveitis. Int Ophthalmol Clin. Winter 2002;42(1):43-8. [Medline].

  25. Kawasaki A, Borruat FX. An unusual presentation of herpes zoster ophthalmicus: orbital myositis preceding vesicular eruption. Am J Ophthalmol. Sep 2003;136(3):574-5. [Medline].

  26. Wang AG, Liu JH, Hsu WM, et al. Optic neuritis in herpes zoster ophthalmicus. Jpn J Ophthalmol. Sep-Oct 2000;44(5):550-4. [Medline].

  27. Tabery HM. Corneal epithelial keratitis in herpes zoster ophthalmicus: "delayed" and "sine herpete". A non-contact photomicrographic in vivo study in the human cornea. Eur J Ophthalmol. Jul-Aug 2002;12(4):267-75. [Medline].

  28. Tabery HM. Morphology of epithelial keratitis in herpes zoster ophthalmicus. A non-contact photomicrographic in vivo study in the human cornea. Acta Ophthalmol Scand. Dec 2000;78(6):651-5. [Medline].

  29. Thean JH, Hall AJ, Stawell RJ. Uveitis in Herpes zoster ophthalmicus. Clin Experiment Ophthalmol. Dec 2001;29(6):406-10. [Medline].

  30. Tranos PG, Ong T, Nolan W, et al. Posterior scleritis presenting with annular choroidal detachment as a complication of herpes zoster ophthalmicus. Retina. Oct 2003;23(5):716-7. [Medline].

  31. Van der Lelij A, Ooijman FM, Kijlstra A, et al. Anterior uveitis with sectoral iris atrophy in the absence of keratitis: a distinct clinical entity among herpetic eye diseases. Ophthalmology. Jun 2000;107(6):1164-70. [Medline].

  32. Al-Muammar A, Jackson WB. Management of ophthalmic zoster mucous plaque keratopathy: report of three cases. Can J Ophthalmol. Feb 2004;39(1):74-6. [Medline].

  33. Assal F, Frank HG, von Gunten S, et al. Internal ophthalmoplegia as a presenting sign of herpes zoster ophthalmicus. Eur Neurol. 2001;45(3):189-90. [Medline].

  34. Devulder JE. Postherpetic ophthalmic neuralgia. Bull Soc Belge Ophtalmol. 2002;19-23. [Medline].

  35. Horton JC. Neurovisual manifestations of herpesviruses. Int Ophthalmol Clin. 2002;42(1):33-41. [Medline].

  36. Krasnianski M, Sievert M, Bau V, et al. External ophthalmoplegia due to ocular myositis in a patient with ophthalmic herpes zoster. Neuromuscul Disord. Jul 2004;14(7):438-41. [Medline].

  37. Pandey PK, Chaudhuri Z, Sharma P. Extraocular muscle and facial paresis in herpes zoster ophthalmicus. J Pediatr Ophthalmol Strabismus. Nov-Dec 2001;38(6):363-6. [Medline].

  38. Yong VK, Yip CC, Yong VS. Herpes zoster ophthalmicus and the superior orbital fissure syndrome. Singapore Med J. Oct 2001;42(10):485-6. [Medline].

  39. Obata H, Yamagami S, Saito S, et al. A case of acute dacryoadenitis associated with herpes zoster ophthalmicus. Jpn J Ophthalmol. Jan-Feb 2003;47(1):107-9. [Medline].

  40. Verm AM, Scott IU, Davis JL. Necrotizing herpetic retinopathy associated with Ramsay Hunt syndrome. Arch Ophthalmol. Jul 2002;120(7):989-90. [Medline].

  41. Atzori L, Ferreli C, Zucca M, et al. Facial cellulitis associated with Pseudomonas aeruginosa complicating ophthalmic herpes zoster. Dermatol Online J. Oct 15 2004;10(2):20. [Medline].

  42. Argoff CE, Katz N, Backonja M. Treatment of postherpetic neuralgia: a review of therapeutic options. J Pain Symptom Manage. Oct 2004;28(4):396-411. [Medline].

  43. Dahlmann A. Pain management in herpes zoster ophthalmicus. J R Soc Med. Jun 2000;93(6):334-5. [Medline].

  44. Sra KK, Tyring SK. Treatment of postherpetic neuralgia. Skin Therapy Lett. Oct 2004;9(8):1-4. [Medline].

  45. Zaal MJ, Völker-Dieben HJ, D'Amaro J. Risk and prognostic factors of postherpetic neuralgia and focal sensory denervation: a prospective evaluation in acute herpes zoster ophthalmicus. Clin J Pain. Dec 2000;16(4):345-51. [Medline].

  46. Harding SP, Lipton JR, Wells JC. Natural history of herpes zoster ophthalmicus: predictors of postherpetic neuralgia and ocular involvement. Br J Ophthalmol. May 1987;71(5):353-8. [Medline].

  47. MacMahon EM. Concomitant bilateral herpes zoster ophthalmicus. Lancet Infect Dis. Jan 2003;3(1):12. [Medline].

  48. Matthews BN, Erb N, Gordon C, et al. Unilateral varicella zoster virus ophthalmicus and contralateral acute retinal necrosis. Eye. Nov 2002;16(6):778-80. [Medline].

  49. Zaal MJ, Volker-Dieben HJ, D'Amaro J. Prognostic value of Hutchinson's sign in acute herpes zoster ophthalmicus. Graefes Arch Clin Exp Ophthalmol. Mar 2003;241(3):187-91. [Medline].

  50. Chronister CL. Review of external ocular disease associated with aids and HIV infection. Optom Vis Sci. Apr 1996;73(4):225-30. [Medline].

  51. Foster RE, Petersen MR, Neuss MN, et al. Progressive outer retinal necrosis syndrome in a lymphoma patient with good visual outcome. Am J Ophthalmol. Jul 2001;132(1):117-20. [Medline].

  52. Hodge WG, Seiff SR, Margolis TP. Ocular opportunistic infection incidences among patients who are HIV positive compared to patients who are HIV negative. Ophthalmology. May 1998;105(5):895-900. [Medline].

  53. Kezuka T. Immune deviation and ocular infections with varicella zoster virus. Ocul Immunol Inflamm. Mar 2004;12(1):17-24. [Medline].

  54. Margolis TP, Milner MS, Shama A, et al. Herpes zoster ophthalmicus in patients with human immunodeficiency virus infection. Am J Ophthalmol. Mar 1998;125(3):285-91. [Medline].

  55. Peck R, Gimple SK, Gregory DW, et al. Progressive outer retinal necrosis in a 73-year-old man: treatment with valganciclovir. AIDS. May 2 2003;17(7):1110-1. [Medline].

  56. Purdy KW, Heckenlively JR, Church JA, et al. Progressive outer retinal necrosis caused by varicella-zoster virus in children with acquired immunodeficiency syndrome. Pediatr Infect Dis J. Apr 2003;22(4):384-6. [Medline].

  57. Rao NA. Acquired immunodeficiency syndrome and its ocular complications. Indian J Ophthalmol. Jun 1994;42(2):51-63. [Medline].

  58. Walton RC, Reed KL. Herpes zoster ophthalmicus following bone marrow transplantation in children. Bone Marrow Transplant. Jun 1999;23(12):1317-20. [Medline].

  59. Yau TH, Butrus SI. Presumed bilateral herpes zoster ophthalmicus in an AIDS patient: a case report. Cornea. Nov 1996;15(6):633-4. [Medline].

  60. Bert RJ, Samawareerwa R, Melhem ER. CNS MR and CT findings associated with a clinical presentation of herpetic acute retinal necrosis and herpetic retrobulbar optic neuritis: five HIV-infected and one non-infected patients. AJNR Am J Neuroradiol. Nov-Dec 2004;25(10):1722-9. [Medline].

  61. Gariano RF, Berreen JP, Cooney EL. Progressive outer retinal necrosis and acute retinal necrosis in fellow eyes of a patient with acquired immunodeficiency syndrome. Am J Ophthalmol. Sep 2001;132(3):421-3. [Medline].

  62. Neves RA, Rodriguez A, Power WJ, et al. Herpes zoster peripheral ulcerative keratitis in patients with the acquired immunodeficiency syndrome. Cornea. Sep 1996;15(5):446-50. [Medline].

  63. Benz MS, Glaser JS, Davis JL. Progressive outer retinal necrosis in immunocompetent patients treated initially for optic neuropathy with systemic corticosteroids. Am J Ophthalmol. Apr 2003;135(4):551-3. [Medline].

  64. Kaye SB, Baker K, Bonshek R, et al. Human herpesviruses in the cornea. Br J Ophthalmol. Jun 2000;84(6):563-71. [Medline].

  65. Nakashizuka H, Yamazaki Y, Tokumaru M, et al. Varicella-zoster viral antigen identified in iridocyclitis patient. Jpn J Ophthalmol. Jan-Feb 2002;46(1):70-3. [Medline].

  66. Nishi M, Hanashiro R, Mori S, et al. Polymerase chain reaction for the detection of the varicella-zoster genome in ocular samples from patients with acute retinal necrosis. Am J Ophthalmol. Nov 15 1992;114(5):603-9. [Medline].

  67. Stavrou P, Mitchell SM, Fox JD, et al. Detection of varicella-zoster virus DNA in ocular samples from patients with uveitis but no cutaneous eruption. Eye. 1994;8 (Pt 6):684-7. [Medline].

  68. Wenkel H, Rummelt V, Fleckenstein B, et al. Detection of varicella zoster virus DNA and viral antigen in human eyes after herpes zoster ophthalmicus. Ophthalmology. Jul 1998;105(7):1323-30. [Medline].

  69. Aslanides IM, De Souza S, Wong DT, et al. Oral valacyclovir in the treatment of acute retinal necrosis syndrome. Retina. Jun 2002;22(3):352-4. [Medline].

  70. Colin J, Prisant O, Cochener B, et al. Comparison of the efficacy and safety of valaciclovir and acyclovir for the treatment of herpes zoster ophthalmicus. Ophthalmology. Aug 2000;107(8):1507-11. [Medline].

  71. Hoang-Xuan T, Buchi ER, Herbort CP, et al. Oral acyclovir for herpes zoster ophthalmicus. Ophthalmology. Jul 1992;99(7):1062-70; discussion 1070-1. [Medline].

  72. Kaufman HE. Treatment of viral diseases of the cornea and external eye. Prog Retin Eye Res. Jan 2000;19(1):69-85. [Medline].

  73. Lancet. Treatment of ocular herpes zoster. Lancet. Nov 16 1991;338(8777):1244-5. [Medline].

  74. Marsh RJ, Cooper M. Double-masked trial of topical acyclovir and steroids in the treatment of herpes zoster ocular inflammation. Br J Ophthalmol. Sep 1991;75(9):542-6. [Medline].

  75. Neoh C, Harding SP, Saunders D, et al. Comparison of topical and oral acyclovir in early herpes zoster ophthalmicus. Eye. 1994;8 (Pt 6):688-91. [Medline].

  76. Pepose JS. The potential impact of the varicella vaccine and new antivirals on ocular disease related to varicella-zoster virus. Am J Ophthalmol. Feb 1997;123(2):243-51. [Medline].

  77. Shaikh S, Ta CN. Evaluation and management of herpes zoster ophthalmicus. Am Fam Physician. Nov 1 2002;66(9):1723-30. [Medline].

  78. Temple JJ. Herpes zoster ophthalmicus: how is it identified and treated?. J Am Acad Nurse Pract. Jul 2002;14(7):297-303; quiz 304-6. [Medline].

  79. Pavan-Langston D. Herpes zoster antivirals and pain management. Ophthalmology. Feb 2008;115(2 Suppl):S13-20. [Medline].

  80. Douglas MW, Johnson RW, Cunningham AL. Tolerability of treatments for postherpetic neuralgia. Drug Saf. 2004;27(15):1217-33. [Medline].

  81. Evans RW, Lee AG. Herpes zoster ophthalmicus, ophthalmoplegia, and trauma. Headache. Mar 2004;44(3):286-8. [Medline].

  82. Zimmerman TJ, Kooner KS, Shariv M, et al. Textbook of Ocular Pharmacology. Philadelphia: Lippincott Raven; 1997.

  83. Chen HJ, Pires RT, Tseng SC. Amniotic membrane transplantation for severe neurotrophic corneal ulcers. Br J Ophthalmol. Aug 2000;84(8):826-33. [Medline].

  84. Tanure MA, Cohen EJ, Grewal S, et al. Penetrating keratoplasty for varicella-zoster virus keratopathy. Cornea. Mar 2000;19(2):135-9. [Medline].

  85. Kaufman SC. Use of photorefractive keratectomy in a patient with a corneal scar secondary to herpes zoster ophthalmicus. Ophthalmology. Feb 2008;115(2 Suppl):S33-4. [Medline].

  86. Pavan-Langston D, Dohlman CH. Boston keratoprosthesis treatment of herpes zoster neurotrophic keratopathy. Ophthalmology. Feb 2008;115(2 Suppl):S21-3. [Medline].

  87. Gelb LD. Preventing herpes zoster through vaccination. Ophthalmology. Feb 2008;115(2 Suppl):S35-8. [Medline].

  88. Naseri A, Good WV, Cunningham ET Jr. Herpes zoster virus sclerokeratitis and anterior uveitis in a child following varicella vaccination. Am J Ophthalmol. Mar 2003;135(3):415-7. [Medline].

  89. Miserocchi E, Waheed NK, Dios E, et al. Visual outcome in herpes simplex virus and varicella zoster virus uveitis: a clinical evaluation and comparison. Ophthalmology. Aug 2002;109(8):1532-7. [Medline].

  90. Zaal MJ, Volker-Dieben HJ, D'Amaro J. Visual prognosis in immunocompetent patients with herpes zoster ophthalmicus. Acta Ophthalmol Scand. Jun 2003;81(3):216-20. [Medline].

  91. Goon P, Wright M, Fink C. Ophthalmic zoster sine herpete. J R Soc Med. Apr 2000;93(4):191-2. [Medline].

  92. Iino Y, Tanaka M, Hatano N, et al. A case of a five-year-old boy with acute retinal necrosis. Retina. Apr 2002;22(2):225-8. [Medline].

  93. Jarade EF, Tabbara KF. Presumed reactivation of herpes zoster ophthalmicus following laser in situ keratomileusis. J Refract Surg. Jan-Feb 2002;18(1):79-80. [Medline].

  94. McKelvie PA, Francis IC, Watson S, et al. Multifocal chorioretinal atrophy associated with herpes zoster ophthalmicus. Clin Experiment Ophthalmol. Dec 2001;29(6):429-32. [Medline].

  95. Morse LS, Mizoguchi M. Diagnosis and management of viral retinitis in the acute retinal necrosis syndrome. Semin Ophthalmol. Mar 1995;10(1):28-41. [Medline].

  96. Nakamura M, Tanabe M, Yamada Y, et al. Zoster sine herpete with bilateral ocular involvement. Am J Ophthalmol. Jun 2000;129(6):809-10. [Medline].

  97. Nakanishi F, Takahashi H, Ohara K. Acute retinal necrosis following contralateral herpes zoster ophthalmicus. Jpn J Ophthalmol. Sep-Oct 2000;44(5):561-4. [Medline].

  98. Noda Y, Nakazawa M, Takahashi D, et al. Retinal periphlebitis as zoster sine herpete. Arch Ophthalmol. Oct 2001;119(10):1550-2. [Medline].

  99. Parisi ML. A case of recurrent, isolated, simultaneous, bilateral herpes simplex lid infection. J Am Optom Assoc. Jan 1998;69(1):49-56. [Medline].

  100. Physicians' Desk Reference. New Jersey: Medical Economics; 1999.

  101. Scott IU, Luu KM, Davis JL. Intravitreal antivirals in the management of patients with acquired immunodeficiency syndrome with progressive outer retinal necrosis. Arch Ophthalmol. Sep 2002;120(9):1219-22. [Medline].

  102. Takei H, Ohno-Matsui K, Hayano M, et al. Indocyanine green angiographic findings in acute retinal necrosis. Jpn J Ophthalmol. May-Jun 2002;46(3):330-5. [Medline].

  103. Walters G, James TE. Viral causes of the acute retinal necrosis syndrome. Curr Opin Ophthalmol. Jun 2001;12(3):191-5. [Medline].

  104. Yoser SL, Forster DJ, Rao NA. Systemic viral infections and their retinal and choroidal manifestations. Surv Ophthalmol. Mar-Apr 1993;37(5):313-52. [Medline].

  105. Zambarakji HJ, Obi AA, Mitchell SM. Successful treatment of varicella zoster virus retinitis with aggressive intravitreal and systemic antiviral therapy. Ocul Immunol Inflamm. Mar 2002;10(1):41-6. [Medline].

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Further Reading

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Keywords

herpes zoster, herpes zoster ophthalmicus, varicella-zoster virus, chickenpox, shingles, varicella, postherpetic neuralgia, herpes zoster oticus, Ramsay Hunt Syndrome, dermatomal zoster, zona, Hutchinson sign, VZV, HZO

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Contributor Information and Disclosures

Author

Manolette R Roque, MD, MBA, President and CEO, Service Chief of Ocular Immunology and Uveitis, Refractive Surgery, EYE REPUBLIC Ophthalmology Clinic; General Manager, Ophthalmic Consultants Philippines; Section Chief of Ocular Immunology and Uveitis, Department of Ophthalmology, Asian Hospital and Medical Center; Section Chief of Ocular Immunology and Uveitis, Department of Ophthalmology, St. Luke's Medical Center Global City; Senior Eye Surgeon, The LASIK Surgery Clinic
Manolette R Roque, MD, MBA is a member of the following medical societies: American Academy of Ophthalmic Executives, American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, American Society of Ophthalmic Administrators, American Uveitis Society, International Ocular Inflammation Society, Philippine Medical Association, Philippine Ocular Inflammation Society, and Philippine Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Barbara L Roque, MD, Full Partner, Ophthalmic Consultants Philippines Co, Chief of Service, Pediatric Ophthalmology and Strabismus, Consulting Staff, Orbit and Eye Plastics, Eye Republic Ophthalmology Clinic
Disclosure: Nothing to disclose.

C Stephen Foster, MD, FACS, FACR, FAAO, Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; Founder and President, Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institution
C Stephen Foster, MD, FACS, FACR, FAAO is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Association of Immunologists, American College of Rheumatology, American College of Surgeons, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, American Uveitis Society, Association for Research in Vision and Ophthalmology, Massachusetts Medical Society, Royal Society of Medicine, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Kilbourn Gordon III, MD, FACEP, Urgent Care Physician
Kilbourn Gordon III, MD, FACEP is a member of the following medical societies: American Academy of Ophthalmology and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

R Christopher Walton, MD, Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, Assistant Dean for Graduate Medical Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital
R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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