eMedicine Specialties > Ophthalmology > Infectious Disease
Herpes Zoster: Treatment & Medication
Updated: Oct 28, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
Current therapeutic strategies for acute herpes zoster ophthalmicus include antiviral agents, systemic corticosteroids, antidepressants, and adequate pain control.69,70,20,71,72,73,74,75,76,77,24,78
- Treatment of acute herpes zoster ophthalmicus is optimal if started within 72 hours of rash onset. Pavan-Langston has outlined the following protocol for treatment79 :
- Oral antiviral drugs (eg, famciclovir 500 mg 3 times/d [tid], valacyclovir 1 g tid, or acyclovir 800 mg 5 times/d for 7 d)
- Tricyclic antidepressants nortriptyline, amitriptyline, or desipramine 25 mg, adjust up to 75 mg at bedtime (qhs) for several weeks if needed (to inhibit acute and prolonged postherpetic neuralgia [PHN]).
- Additional topical corticosteroids, antibiotics, cycloplegics, antivirals, and glaucoma medications as necessary for keratitis, iritis, or glaucoma.
- Treat late PHN with tricyclic antidepressants (as listed above) and/or capsaicin ointment daily (qd) or 4 times/day (qid) or lidocaine patches. Neurontin 30-600 mg by mouth (PO) tid and/or OxyContin SR 10-20 mg PO 2 times/day (bid) with topical medications similar to those used in acute disease.43,80,81
- Virustatic agents that are dependent on viral thymidine kinase phosphorylation and targeted at viral polymerase include acyclovir, valacyclovir, penciclovir, famciclovir, sorivudine, and bromovinyldeoxyuridine.82
- Virustatic agents that not dependent on viral thymidine kinase phosphorylase and targeted at viral polymerase include vidarabine, foscarnet, and cidofovir (hydroxyphosphonylmethoxypropyl).82
Surgical Care
Some patients may require minor surgical procedures, such as a lateral tarsorrhaphy or lid traction sutures. In other patients with widespread corneal scarring, penetrating keratoplasty may be performed.83,84,85,86
Consultations
- Ophthalmic care is required if there is ocular involvement (eg, globe, lids) and/or if the tip of the nose is involved (herpes zoster ophthalmicus).
- Counseling with a psychiatrist may be necessary in patients with excruciating pain due to PHN.
- Additional consultations with an anesthesiologist in a pain clinic may be warranted in severe cases of PHN.
- Consider consulting an ear, nose, and throat (ENT) specialist if otalgia and/or eruptions are present around the external auditory canal and pinna.
- In rare cases, consultation with a surgeon is required for debridement of any involved epithelium.
- Consultation with an infectious disease specialist should be considered in cases of disseminated zoster or zoster with visceral involvement.
Medication
The goal of pharmacotherapy is to reduce morbidity and to prevent complications.
Antivirals
Antivirals are indicated for the treatment of acute herpes zoster (shingles). It also is indicated for the treatment or suppression of genital herpes.
Acyclovir (Zovirax)
Synthetic purine nucleoside analogue with in vitro and in vivo inhibitory activity against herpes simplex virus types 1 (HSV-1), 2 (HSV-2), and VZV.
Adult
Acute treatment: 800 mg q4h PO 5 times/d for 7 d
Chronic suppressive therapy for recurrent disease: 400 mg bid up to 12 mo, followed by reevaluation
Pediatric
Suggested dose is 10-20 mg/kg/dose qid for 5 d; not to exceed 800 mg
Concomitant probenecid or zidovudine prolongs half-life and increases CNS toxicity of acyclovir
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Dosage adjustment recommended in renal impairment; coadministration with potentially nephrotoxic agents may increase risk of renal dysfunction and/or risk of reversible CNS symptoms
Famciclovir (Famvir)
Orally administered prodrug of antiviral agent penciclovir. Indicated to treat acute herpes zoster or suppression of genital herpes. Initiate as soon as herpes zoster is diagnosed.
Adult
500 mg q8h for 7 d
Pediatric
Not established
Coadministration of probenecid or cimetidine may increase toxicity; coadministration increases bioavailability of digoxin; interactions with drugs metabolized by aldehyde oxidase (6-deoxy penciclovir to penciclovir) can occur; no clinically significant alterations in penciclovir pharmacokinetics observed after single-dose administration of famciclovir 500 mg after pretreatment with multiple doses of allopurinol, cimetidine, theophylline, or zidovudine; no clinically significant effects on penciclovir pharmacokinetics observed after multiple-dose (tid) administration of famciclovir 500 mg with multiple doses of digoxin; steady-state pharmacokinetics of digoxin not altered by concomitant administration of multiple doses of famciclovir 500 mg tid; no clinically significant effects on pharmacokinetics of zidovudine or zidovudine glucuronide observed after a single oral dose of famciclovir 500 mg
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Efficacy has not been established for initial episode genital herpes infection, ophthalmic zoster, disseminated zoster, or in immunocompromised patients with herpes zoster; adjust dose when creatinine clearance <60 mL/min
Valacyclovir (Valtrex)
Hydrochloride salt of L-valyl ester of antiviral drug acyclovir. Rapidly converted to acyclovir. Indicated to treat acute herpes zoster (shingles) and for suppression of genital herpes.
Adult
1 g tid for 7 d; initiate therapy at earliest sign or symptoms; most effective when started within 48 h of onset of zoster rash
Pediatric
Not established
Probenecid, zidovudine, or cimetidine coadministration prolongs half-life and may increase CNS toxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (sometimes resulting in death) has occurred in advanced HIV disease, allogeneic bone marrow transplant, and renal transplant recipients in clinical trials of Valtrex at doses of 8 g qd; caution in renal failure and coadministration of nephrotoxic drugs; associated with onset of hemolytic uremic syndrome
Vidarabine (Vira-A 3%)
Antiviral drug for topical treatment of epithelial keratitis caused by HSV. Purine nucleoside obtained from fermentation cultures of Streptomyces antibioticus. Antiviral mechanism not established. Appears to interfere with early steps of viral DNA synthesis. Antiviral activity against viruses in vitro: HSV types 1 and 2, vaccinia, VZV, rhabdovirus, and oncornavirus.
Adult
Apply 0.5-inch ribbon into lower conjunctival sac(s) 5 times/d q3h
After 5-7 d, corneal epithelialization should begin; approximately 3 wk of treatment may be required for complete reepithelialization
If no signs of improvement after a week or if incomplete reepithelialization occurs by 3 wk, consider other forms of topical therapy
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Viral resistance to vidarabine possible but not reported; diagnosis of keratoconjunctivitis due to HSV should be clinically established before therapy; warn patients that Vidarabine (like other ophthalmic ointments) may cause visual blurring; adverse effects (eg, lacrimation, foreign body sensation, conjunctival injection, burning, irritation, superficial punctate keratitis, pain, photophobia, punctal occlusion, and sensitivity) reported
Ganciclovir (Vitrasert, Cytovene)
Synthetic guanine derivative active against CMV. Acyclic nucleoside analog of 2'-deoxyguanosine that inhibits replication of herpes viruses in vitro and in vivo. Ganciclovir-triphosphate levels as much as 100-fold greater in CMV-infected cells than in uninfected cells, possibly because of preferential phosphorylation. If CMV retinitis progresses during maintenance treatment with either dosage form, administer reinduction regimen.
Adult
Prevention of CMV disease in patients with advanced HIV infection and normal renal function: 1000 mg PO tid with food
Pediatric
Safety and efficacy in pediatric population have not been established; oral ganciclovir has not been studied in children <13 years
<3 years: Not established
>3 years: Administer as in adults
Concomitant administration with cytotoxic drugs (eg, dapsone, vinblastine, Adriamycin, pentamidine, flucytosine, vincristine, amphotericin B, trimethoprim/sulfamethoxazole combinations, other nucleoside analogs) may result in additive toxicity in bone marrow, spermatogonia, and germinal layers of skin and GI mucosa (coadminister only if potential benefits outweigh risks); coadministration with imipenem-cilastatin may cause generalized seizures (use only if potential benefits outweigh risks); serum creatinine level may increase after concurrent use of ganciclovir and cyclosporine or amphotericin B; probenecid reduces renal clearance of ganciclovir; bioavailability may increase when didanosine is administered with or 2 h before ganciclovir; bioavailability may decrease with zidovudine; may increase bioavailability of zidovudine
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Clinical toxicity includes granulocytopenia, anemia and thrombocytopenia; because oral form associated with increased rate of CMV retinitis progression, as compared with IV form, use only when benefits outweigh risks (advanced HIV disease); half-life and plasma/serum concentrations may be increased due to reduced renal clearance; doses > 6 mg/kg IV and rapid infusion may increase toxicity; initially reconstituted IV solutions have a high pH (ie, 11); phlebitis or pain may occur at infusion site despite further dilution in IV fluids; administer with adequate hydration; photosensitization (photoallergy or phototoxicity) may occur
Interferons
These drugs are naturally produced proteins with antiviral, antitumor, and immunomodulatory actions. Alpha, beta, and gamma interferons may be given topically, systemically, or intralesionally.
Interferon alfa-2a and alfa-2b (Roferon, Intron A)
Protein product manufactured by recombinant DNA technology. Mechanism of antitumor activity not clearly understood; however, direct antiproliferative effects against malignant cells and modulation of host immune response may play important roles.
Adult
2 million U/m2 SC 3 times/wk for 30 d
Pediatric
Not established
Theophylline may increase toxicity; cimetidine may increase antitumor effects; zidovudine and vinblastine may increase toxicity
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in brain metastases, severe hepatic or renal insufficiencies, seizure disorders, multiple sclerosis, or compromised CNS
Blood and blood products
Blood and blood products are used to improve the clinical and immunologic aspects of a disease. They may decrease autoantibody production, and increase solubilization and removal of immune complexes.
Immune globulins intravenous (IVIG, Gammagard, Gamimune)
Following features may be relevant to efficacy: neutralization of circulating myelin antibodies with anti-idiotypic antibodies; down-regulation of proinflammatory cytokines, including IFN-gamma; blockade of Fc receptors on macrophages; suppression of inducer T and B cells and augmentation of suppressor T cells; blockade of complement cascade; promotion of remyelination; and 10% increase in CSF IgG level
Adult
2 g/kg IV over 2-5 d
Pediatric
Administer as in adults
None reported
Documented hypersensitivity; IgA deficiency; anti-IgE/IgG antibodies
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Consider checking serum IgA level first and using IgA depleted IVIG (G-Gard-SD), if indicated; IVIG may increase serum viscosity and thromboembolic events
Reported adverse effects: migraine, 10% increased risk of aseptic meningitis; increased risk of urticaria, pruritus or petechiae 2-5 d after infusion that may last <1 mo; increased risk of renal tubular necrosis in older patients, diabetic patients, volume-depleted patients, and in patients with preexisting kidney disease
IVIG can elevate antiviral or antibacterial antibody titers for 1 mo, increase ESR 6-fold for 2-3 wk, cause apparent hyponatremia
Vaccines
Vaccines provide active immunity against viral infections.
Varicella virus vaccine (Varivax)
Attenuated varicella virus vaccine offering active immunity to disease caused by VZV. May administer concomitantly with MMR vaccine. Limited data suggest that coadministration with DTP and Pedvax HIB may be safe.
Adult
2 doses of 0.5 mL separated by 4-8 wk
Pediatric
12 months to 12 years: 0.5 mL
Salicylates may increase risk of Reye syndrome after vaccination; immunosuppressant drugs may inhibit development of active immunity
Documented hypersensitivity; blood dyscrasias; leukemia; lymphomas; malignant neoplasms affecting bone marrow or lymphatic systems; immunosuppressive therapy; primary and acquired immunodeficiency states; untreated tuberculosis; IV injection
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in renal insufficiency; discontinue therapy before performing any surgical procedures; impaired liver function
Varicella zoster vaccine
Lyophilized preparation of Oka/Merck strain of live, attenuated varicella-zoster virus (VZV). Shown to boost immunity against herpes zoster virus (shingles) in older patients. Reduces occurrence of shingles in individuals >60 y by about 50%. For individuals aged 60-69 y, it reduces occurrence by 64%. Also slightly reduces pain compared with no vaccination in those who develop shingles. Indicated for prevention of herpes zoster.
Adult
<60 years: Not established
>60 years: Following reconstitution with entire vial of diluent supplied, use separate sterile needle and syringe to withdraw entire contents of reconstituted vial and administer SC; administer in upper arm
Pediatric
Not indicated
None reported
Documented hypersensitivity to vaccine or components (eg, gelatin, neomycin); history of primary or acquired immunodeficiency states (eg, leukemia, lymphomas, malignant neoplasms affecting bone marrow or lymphatic system, AIDS); immunosuppressive therapy, including high-dose corticosteroids; active, untreated tuberculosis
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Common adverse effects include erythema, pain, tenderness, itching, and inflammation at injection site; may also cause headache; may cause extensive vaccine-associated rash or disseminated disease in individuals on immunosuppressive therapy; defer vaccination if fever or acute illness present; do not inject intravascularly; administer within 30 min of reconstitution; not a substitute for varicella virus vaccine (Varivax) for children
Corticosteroids
These agents help to relieve acute pain, decrease vertigo, and limit the development of PHN.
Prednisone (Deltasone)
Inactive and must be metabolized to active metabolite prednisone. Conversion may be impaired in liver disease.
Adult
5-60 mg/d PO qd or divided bid/qid; taper over 2 wk, as symptoms resolve
Pediatric
4-5 mg/m2/d PO; alternatively, 0.05-2 mg/kg PO divided bid/qid; taper over 2 wk, as symptoms resolve
Corticosteroids may decrease I-131 uptake and produce false-negative results on nitroblue tetrazolium test for systemic bacterial infection; coadministration with estrogens may decrease clearance; concurrent digoxin may cause digitalis toxicity due to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics.
Documented hypersensitivity; viral infection, peptic ulcer disease, hepatic dysfunction, connective tissue infections, and fungal or tubercular skin infections; GI disease.
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Because complications of treatment with corticosteroids depend on dose and duration, weigh risks and benefits for dose, duration, and daily vs intermittent therapy; use lowest possible dose to control condition; psychic derangements may appear (eg, euphoria, insomnia, mood swings, personality changes, severe depression, frank psychotic manifestations); existing emotional instability or psychotic tendencies may be aggravated; avascular or aseptic necrosis of femoral head associated with long-term corticosteroid treatment (also in high-dose, short-term therapy); adverse effect more likely with predisposing illness (eg, rheumatoid arthritis or systemic lupus erythematosus); enhanced effect in hypothyroidism and in cirrhosis; aspirin and NSAIDs should be used cautiously with corticosteroids in hypoprothrombinemia; in patients receiving therapy and unusual stress, increase dose of rapidly acting corticosteroids before, during, and after stressful situation; restrict use in active tuberculosis to cases of
fulminating disseminated tuberculosis in which corticosteroid is used to manage the disease in conjunction with appropriate antituberculous regimen; if corticosteroids indicated in latent tuberculosis or tuberculin reactivity, close observation is necessary, as disease reactivation may occur (during prolonged corticosteroid therapy, patients should receive chemoprophylaxis); may mask signs of infection, and new infections may appear during use; possible decreased resistance and inability to localize infection; if corticosteroids must be used in bacterial infections, give appropriate anti-infective therapy; patients exposed to certain infections (eg, measles, chickenpox) should seek medical advice; may activate latent amebiasis; rule out amebiasis before giving corticosteroids to a patient who has spent time in the tropics or who has unexplained diarrhea.
Analgesics
Pain control is essential to providing quality patient care. Analgesics ensure patient comfort and have sedating properties that are beneficial for patients who have sustained trauma or have painful lesions. Various narcotic agents are available individually or in combination with acetaminophen, aspirin, or NSAIDs.
Oxycodone and aspirin (Percodan)
Indicated for relief of moderate to severe pain. Percodan 5/325 mg; Percodan Demi 2.5/325 mg.
Adult
Moderate to severe pain: 1 tab (5/325 mg) PO q6h prn; 1-2 tabs (2.5/325 mg) q6h prn.
Pediatric
Not FDA approved
Unapproved use: 6-12 years: one-fourth Demi tab PO q6h prn moderate to severe pain
>12 years: one-half Demi tab PO q6h prn moderate to severe pain
Increases effects of anticoagulants; cimetidine increases respiratory and CNS depression; in combination, CNS depressants increase risk of CNS depression; phenytoin may decrease concentration; rifampin may decrease concentration
Documented hypersensitivity; severe respiratory depression; liver and/or kidney disease
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Serious reactions include seizures, respiratory depression; opioids, carisoprodol, and butalbital may be habit forming (dependency, abuse); avoid exceeding acetaminophen 4 g/d in combination products (neutropenia and hemolytic anemia); alcohol, sedatives, and tranquilizers may enhance drowsiness and/or sedation; common reactions are weakness, lightheadedness, nausea, vomiting, constipation, physical dependence, sedation, somnolence, dizziness, euphoria, dry mouth, hypotension, urinary retention, and respiratory depression
Oxycodone and acetaminophen (Percocet, Tylox)
Percocet 2.5/325, Percocet 5/325 Percocet 7.5/500, Percocet 10/650. Generic oxycodone/acetaminophen 5 mg/325 mg.
Adult
Moderate pain: 1-2 tabs PO q4-6h prn; not to exceed 8 g/d acetaminophen, 4 g/d in alcoholism
Pediatric
Not applicable
Increases effects of anticoagulants; cimetidine increases respiratory and CNS depression; in combination, CMS depressants increase risk of CNS depression; phenytoin may decrease concentration; rifampin may decrease concentration
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution is advised in elderly patients and patients with impaired liver function, acute abdomen, prostatic hypertrophy, GI ileus, and/or obstruction; opiate abuse is warning sign; serious adverse reactions include seizures, respiratory depression, and hepatotoxicity; opioids, carisoprodol, and butalbital may be habit-forming (dependency, abuse); avoid exceeding acetaminophen 4 g/d in combination products; alcohol, sedatives, and tranquilizers may enhance drowsiness and/or sedation; common adverse reactions are dizziness, sedation, nausea, vomiting, constipation, dysphoria, confusion, rash, pruritus, physical dependence, urinary retention, and seizures
Hydrocodone and acetaminophen (Lortab)
Lortab 2.5/500 mg, 5/500 mg, 7.5/500 mg, or 10/500 mg. Generic hydrocodone/acetaminophen 5/500 mg; Trade and generic elixir: 7.5/500 mg hydrocodone/acetaminophen per 15 mL
Adult
1-2 tabs 2.5/500 mg and 5/500 mg PO q4-6h prn moderate pain; not to exceed 8 tabs/d
1 tab 7.5/500 and 10/500 PO q4-6h prn; not to exceed 5 tabs/d
Elixir 15 mL PO q4-6h prn; not to exceed 6 doses/d
Pediatric
Not approved by the FDA
Chronic alcohol use increases risk of hepatotoxicity; combination with anticholinergics and/or antidiarrheals increases risk of severe constipation; combination with CNS depressants increases risk of CNS depression; combination with isoniazid increases risk of hepatotoxicity; combination use with MAOIs increases risk of severe hypertension; combination with tricyclic antidepressants increases concentration of both drugs
Documented hypersensitivity; patients with depressed respiratory function
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution advised in elderly patients and patients with head injury, increased ICP, impaired renal function, G-6-PD deficiency, impaired liver function, impaired pulmonary function, chronic alcohol abuse, and/or bowel obstruction; serious adverse reactions are pancytopenia, thrombocytopenia, hepatotoxicity, respiratory depression, convulsions, severe hypotension, dependency and abuse, and/or paralytic ileus; common adverse reactions are lightheadedness, sedation, dizziness, constipation, nausea, vomiting, hypotension, urinary retention, and/or miosis
Tricyclic antidepressants
These drugs are used for pain relief, especially in cases of PHN.
Amitriptyline (Elavil)
Generic/trade: tablets 10, 25, 50, 75, 100, and 150 mg.
Adult
Chronic pain: 0.5-2 mg/kg PO qhs; start with 0.1 mg/kg PO qhs, titrate slowly over 2-3 wk; not to exceed 150 mg/d
Depression: 5-100 mg PO qd; start with 50-75 mg PO qd; not to exceed 300 mg/d
Elderly patients: consider divided dose of 10 mg PO tid
Pediatric
Not approved in children <12 years
Chronic pain: 0.5-2 mg/kg PO qhs; start with 0.1 mg/kg PO qhs, titrate slowly over 2-3 wk
Depression (9-12 y): 1-3 mg/kg PO daily divided tid; not to exceed 200 mg/d
Use of adrenergic agents warrants BP monitoring; antagonistic effects, and/or decreased hypertensive efficacy (clonidine, guanethidine, guanadrel, methyldopa) may occur; caution with concomitant barbiturates because of additive/synergistic effects, increased risk of CNS/respiratory depression; avoid combination with cimetidine because of hepatic metabolism inhibition with increased amitriptyline levels/toxicity; use with protease inhibitors inhibits hepatic metabolism, increasing amitriptyline levels/toxicity (amprenavir, indinavir, ritonavir, saquinavir); combination with sympathomimetics increases risk of hypertension, arrhythmia, tachycardia (eg, amphetamine, dextroamphetamine, methylphenidate); with warfarin use, anticoagulant effects may increase because of inhibited hepatic metabolism
Documented hypersensitivity; patients recovering from acute myocardial infarction; use of MAOIs within 14 d (use with MAOIs contraindicated because additive/synergistic effects may precipitate a hypertensive crisis)
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in patients with urinary retention, seizure history, glaucoma, coronary artery disease, thyroid disease, impaired liver function, and/or suicide risk; serious adverse reactions include seizures, myocardial infarction, stroke, agranulocytosis, and/or thrombocytopenia; common adverse reactions include dry mouth, drowsiness, dizziness, constipation, urinary retention, tachycardia, blurred vision, increased appetite, confusion, and/or disorientation; gradually taper dose when discontinuing cyclic antidepressants to avoid withdrawal symptoms after prolonged use
Ocular lubricants
These drugs promote hydration of the cornea and conjunctiva.
Artificial tears (Tears Naturale, Hypo Tears, Lacri-Lube)
Ophthalmic lubricants. Contain equivalent of 0.9% NaCl; used to maintain ocular tonicity. Stabilize and thicken precorneal tear film and prolong its breakup time, which occurs with dry-eye states.
Adult
1-2 gtt tid/qid prn
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
A - Fetal risk not revealed in controlled studies in humans
Precautions
Hyperemia, photophobia, stickiness of eyelashes, ocular discomfort, or irritation may occur
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
Chern KC, Margolis TP. Varicella zoster virus ocular disease. Int Ophthalmol Clin. Fall 1998;38(4):149-60. [Medline].
Kuo YH, Yip Y, Chen SN. Retinal vasculitis associated with chickenpox. Am J Ophthalmol. Oct 2001;132(4):584-5. [Medline].
Ang LP, Au Eong KG, Ong SG. Herpes zoster ophthalmicus. J Pediatr Ophthalmol Strabismus. May-Jun 2001;38(3):174-6. [Medline].
Cockburn DM, Douglas IS. Herpes zoster opthalmicus. Clin Exp Optom. Mar-Apr 2000;83(2):59-64. [Medline].
Gurwood AS, Savochka J, Sirgany BJ. Herpes zoster ophthalmicus. Optometry. May 2002;73(5):295-302. [Medline].
Karbassi M, Raizman MB, Schuman JS. Herpes zoster ophthalmicus. Surv Ophthalmol. May-Jun 1992;36(6):395-410. [Medline].
Marsh RJ, Cooper M. Ophthalmic herpes zoster. Eye. 1993;7 (Pt 3):350-70. [Medline].
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].
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].
Ritterband DC, Friedberg DN. Virus infections of the eye. Rev Med Virol. Oct 1998;8(4):187-201. [Medline].
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].
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].
Karlin JD. Herpes zoster ophthalmicus: the virus strikes back. Ann Ophthalmol. Jun 1993;25(6):208-15. [Medline].
Liesegang TJ. Herpes zoster ophthalmicus natural history, risk factors, clinical presentation, and morbidity. Ophthalmology. Feb 2008;115(2 Suppl):S3-12. [Medline].
Liesegang TJ. Varicella-zoster virus eye disease. Cornea. Sep 1999;18(5):511-31. [Medline].
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].
Ahn M, Cho NC. Central retinal artery occlusion in herpes zoster ophthalmicus. J Pediatr Ophthalmol Strabismus. Mar-Apr 2002;39(2):123-4. [Medline].
Akpek EK, Gottsch JD. Herpes zoster sine herpete presenting with hyphema. Ocul Immunol Inflamm. Jun 2000;8(2):115-8. [Medline].
Berry-Brincat A, Von Lany H, Evans N. Scleromalacia as a complication of herpes zoster ophthalmicus. Eye. Apr 2003;17(3):449-51. [Medline].
Cunningham ET. Diagnosing and treating herpetic anterior uveitis. Ophthalmology. Dec 2000;107(12):2129-30. [Medline].
Foster CS, Sainz de la Maza M. The Sclera. New York, NY: Springer-Verlag; 1994.
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].
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].
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].
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].
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].
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].
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].
Thean JH, Hall AJ, Stawell RJ. Uveitis in Herpes zoster ophthalmicus. Clin Experiment Ophthalmol. Dec 2001;29(6):406-10. [Medline].
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].
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].
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].
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].
Devulder JE. Postherpetic ophthalmic neuralgia. Bull Soc Belge Ophtalmol. 2002;19-23. [Medline].
Horton JC. Neurovisual manifestations of herpesviruses. Int Ophthalmol Clin. 2002;42(1):33-41. [Medline].
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].
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].
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].
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].
Verm AM, Scott IU, Davis JL. Necrotizing herpetic retinopathy associated with Ramsay Hunt syndrome. Arch Ophthalmol. Jul 2002;120(7):989-90. [Medline].
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].
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].
Dahlmann A. Pain management in herpes zoster ophthalmicus. J R Soc Med. Jun 2000;93(6):334-5. [Medline].
Sra KK, Tyring SK. Treatment of postherpetic neuralgia. Skin Therapy Lett. Oct 2004;9(8):1-4. [Medline].
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].
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].
MacMahon EM. Concomitant bilateral herpes zoster ophthalmicus. Lancet Infect Dis. Jan 2003;3(1):12. [Medline].
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].
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].
Chronister CL. Review of external ocular disease associated with aids and HIV infection. Optom Vis Sci. Apr 1996;73(4):225-30. [Medline].
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].
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].
Kezuka T. Immune deviation and ocular infections with varicella zoster virus. Ocul Immunol Inflamm. Mar 2004;12(1):17-24. [Medline].
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].
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].
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].
Rao NA. Acquired immunodeficiency syndrome and its ocular complications. Indian J Ophthalmol. Jun 1994;42(2):51-63. [Medline].
Walton RC, Reed KL. Herpes zoster ophthalmicus following bone marrow transplantation in children. Bone Marrow Transplant. Jun 1999;23(12):1317-20. [Medline].
Yau TH, Butrus SI. Presumed bilateral herpes zoster ophthalmicus in an AIDS patient: a case report. Cornea. Nov 1996;15(6):633-4. [Medline].
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].
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].
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].
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].
Kaye SB, Baker K, Bonshek R, et al. Human herpesviruses in the cornea. Br J Ophthalmol. Jun 2000;84(6):563-71. [Medline].
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].
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].
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].
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].
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].
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].
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].
Kaufman HE. Treatment of viral diseases of the cornea and external eye. Prog Retin Eye Res. Jan 2000;19(1):69-85. [Medline].
Lancet. Treatment of ocular herpes zoster. Lancet. Nov 16 1991;338(8777):1244-5. [Medline].
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].
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].
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].
Shaikh S, Ta CN. Evaluation and management of herpes zoster ophthalmicus. Am Fam Physician. Nov 1 2002;66(9):1723-30. [Medline].
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].
Pavan-Langston D. Herpes zoster antivirals and pain management. Ophthalmology. Feb 2008;115(2 Suppl):S13-20. [Medline].
Douglas MW, Johnson RW, Cunningham AL. Tolerability of treatments for postherpetic neuralgia. Drug Saf. 2004;27(15):1217-33. [Medline].
Evans RW, Lee AG. Herpes zoster ophthalmicus, ophthalmoplegia, and trauma. Headache. Mar 2004;44(3):286-8. [Medline].
Zimmerman TJ, Kooner KS, Shariv M, et al. Textbook of Ocular Pharmacology. Philadelphia: Lippincott Raven; 1997.
Chen HJ, Pires RT, Tseng SC. Amniotic membrane transplantation for severe neurotrophic corneal ulcers. Br J Ophthalmol. Aug 2000;84(8):826-33. [Medline].
Tanure MA, Cohen EJ, Grewal S, et al. Penetrating keratoplasty for varicella-zoster virus keratopathy. Cornea. Mar 2000;19(2):135-9. [Medline].
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].
Pavan-Langston D, Dohlman CH. Boston keratoprosthesis treatment of herpes zoster neurotrophic keratopathy. Ophthalmology. Feb 2008;115(2 Suppl):S21-3. [Medline].
Gelb LD. Preventing herpes zoster through vaccination. Ophthalmology. Feb 2008;115(2 Suppl):S35-8. [Medline].
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].
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].
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].
Goon P, Wright M, Fink C. Ophthalmic zoster sine herpete. J R Soc Med. Apr 2000;93(4):191-2. [Medline].
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].
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].
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].
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].
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].
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].
Noda Y, Nakazawa M, Takahashi D, et al. Retinal periphlebitis as zoster sine herpete. Arch Ophthalmol. Oct 2001;119(10):1550-2. [Medline].
Parisi ML. A case of recurrent, isolated, simultaneous, bilateral herpes simplex lid infection. J Am Optom Assoc. Jan 1998;69(1):49-56. [Medline].
Physicians' Desk Reference. New Jersey: Medical Economics; 1999.
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].
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].
Walters G, James TE. Viral causes of the acute retinal necrosis syndrome. Curr Opin Ophthalmol. Jun 2001;12(3):191-5. [Medline].
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].
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].
Further Reading
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
