eMedicine Specialties > Emergency Medicine > Infectious Diseases

Herpes Zoster Ophthalmicus: Follow-up

Author: Maria M Diaz, MD, Staff Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center
Coauthor(s): Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Contributor Information and Disclosures

Updated: Sep 18, 2008

Follow-up

Further Inpatient Care

  • For patients with herpes zoster ophthalmicus, consider admission for the involvement of multiple dermatomes, immunocompromised conditions, and significant facial bacterial superinfection. IV antiviral medications should be administered as mentioned earlier.

Further Outpatient Care

  • Patients should have adequate and timely outpatient follow-up for management of HZO. Reexamination after 1 week at the most should be scheduled in the initial stages. Antiviral medications should be administered and continued as mentioned above.

Transfer

  • Transfer is rarely, if ever, indicated unless the patient develops systemic manifestations that require a higher level of care that the current hospital can provide.

Deterrence/Prevention

  • Studies have shown that the varicella vaccine in children is highly effective in preventing chickenpox. Nevertheless, reports exist of outbreaks of varicella disease in highly immunized groups.14 Therefore, changes to the current vaccination policy may be anticipated.
  • Based on the results of the Shingles Prevention Study, in 2006, the FDA has approved the Zostavax vaccine for the prevention of herpes zoster in people aged 60 years and older. More than 38,000 adults older than 60 years were enrolled in a randomized, double-blind, placebo-controlled trial of the vaccine. The vaccine reduced the incidence of herpes zoster by 61.1% (p<0.001) and the incidence of postherpetic neuralgia by 66.5% (p<0.001).15  

Complications

  • Other varied-onset ocular sequelae of HZ include problems with perfusion and virus-induced necrosis of the retina. Acute retinal necrosis is characterized by blurred vision, pain, coalescent patches of necrosis, inflammation of vitreous humor, occlusive vasculitis, and detachment of the retina. Progressive outer retinal necrosis syndromes that involve the macula occur in immunocompromised individuals and carry an extremely grave prognosis. Cranial nerve palsies (most commonly the oculomotor nerve) may be related to secondary vasculitis within the orbital apex and usually resolve spontaneously within 6 months. Cases of optic neuritis (swelling of the optic nerve head) have also been reported.
  • Postherpetic neuralgia affects about 7% of patients with HZ, and individuals experience constant or intermittent pain in the distribution of the affected dermatome. It may last from months to years.

Prognosis

  • The course of the disease can become chronic or relapsing since the eye has rendered itself vulnerable. Systemic antiviral therapy can lower the emergence of complications, yet no currently available regimen has been found to eliminate all of the complications.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Cynthia Haeshin Moon, MD, to the development and writing of this article.



More on Herpes Zoster Ophthalmicus

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

  1. Straus SE, Ostrove JM, Inchauspé G, Felser JM, Freifeld A, Croen KD, et al. NIH conference. Varicella-zoster virus infections. Biology, natural history, treatment, and prevention. Ann Intern Med. Feb 1988;108(2):221-37. [Medline].

  2. Ragozzino MW, Melton LJ, Kurland LT, et al. Population-based study of herpes zoster and its sequelae. Medicine (Baltimore). Sep 1982;61(5):310-6. [Medline].

  3. Donahue JG, Choo PW, Manson JE, Platt R. The incidence of herpes zoster. Arch Intern Med. Aug 7-21 1995;155(15):1605-9. [Medline].

  4. Insinga RP, Itzler RF, Pellissier JM, Saddier P, Nikas AA. The incidence of herpes zoster in a United States administrative database. J Gen Intern Med. Aug 2005;20(8):748-53. [Medline].

  5. 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].

  6. Cobo LM, Foulks GN, Liesegang T, et al. Oral acyclovir in the treatment of acute herpes zoster ophthalmicus. Ophthalmology. Jun 1986;93(6):763-70. [Medline].

  7. Severson EA, Baratz KH, Hodge DO, Burke JP. Herpes zoster ophthalmicus in olmsted county, Minnesota: have systemic antivirals made a difference?. Arch Ophthalmol. Mar 2003;121(3):386-90. [Medline].

  8. Tyring S, Engst R, Corriveau C, Robillard N, Trottier S, Van Slycken S, et al. Famciclovir for ophthalmic zoster: a randomised aciclovir controlled study. Br J Ophthalmol. May 2001;85(5):576-81. [Medline].

  9. 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].

  10. Whitley RJ, Weiss H, Gnann JW, et al. Acyclovir with and without prednisone for the treatment of herpes zoster. A randomized, placebo-controlled trial. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Ann Intern Med. Sep 1 1996;125(5):376-83. [Medline].

  11. Wood MJ, Johnson RW, McKendrick MW, et al. A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster. N Engl J Med. Mar 31 1994;330(13):896-900. [Medline].

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

  13. Shafran SD, Tyring SK, Ashton R, et al. Once, twice, or three times daily famciclovir compared with aciclovir for the oral treatment of herpes zoster in immunocompetent adults: a randomized, multicenter, double-blind clinical trial. J Clin Virol. Apr 2004;29(4):248-53. [Medline].

  14. Vazquez M. Varicella zoster virus infections in children after the introduction of live attenuated varicella vaccine. Curr Opin Pediatr. Feb 2004;16(1):80-4. [Medline].

  15. [Best Evidence] Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. Jun 2 2005;352(22):2271-84. [Medline].

  16. Buchbinder SP, Katz MH, Hessol NA, et al. Herpes zoster and human immunodeficiency virus infection. J Infect Dis. Nov 1992;166(5):1153-6. [Medline].

  17. Gnann JW, Whitley RJ. Clinical practice. Herpes zoster. N Engl J Med. Aug 1 2002;347(5):340-6. [Medline].

  18. Gross G, Schofer H, Wassilew S, et al. Herpes zoster guideline of the German Dermatology Society (DDG). J Clin Virol. Apr 2003;26(3):277-89; discussion 291-3. [Medline].

  19. Harding SP, Lipton JR, Wells JC, Campbell JA. Relief of acute pain in herpes zoster ophthalmicus by stellate ganglion block. Br Med J (Clin Res Ed). May 31 1986;292(6533):1428. [Medline].

  20. Hutchinson J. Clinical report on herpes zoster frontalis ophthalmicus. Ophth Hosp Rep. 1864;3(72):865-6, 5:191.

  21. Kattah JC, Kennerdell JS. Orbital apex syndrome secondary to herpes zoster ophthalmicus. Am J Ophthalmol. Mar 1978;85(3):378-82. [Medline].

  22. Liang MG, Heidelberg KA, Jacobson RM, McEvoy MT. Herpes zoster after varicella immunization. J Am Acad Dermatol. May 1998;38(5 Pt 1):761-3. [Medline].

  23. Liesegang TJ. Herpes zoster virus infection. Curr Opin Ophthalmol. Dec 2004;15(6):531-6. [Medline].

  24. Mosby's. Drug Consult (Online reference). 2005.

  25. Opstelten W, van Wijck AJ, Stolker RJ. Interventions to prevent postherpetic neuralgia: cutaneous and percutaneous techniques. Pain. Feb 2004;107(3):202-6. [Medline].

  26. Vafai A, Berger M. Zoster in patients infected with HIV: a review. Am J Med Sci. Jun 2001;321(6):372-80. [Medline].

  27. Zaal MJ, Volker-Dieben HJ, Wienesen M, et al. Longitudinal analysis of varicella-zoster virus DNA on the ocular surface associated with herpes zoster ophthalmicus. Am J Ophthalmol. Jan 2001;131(1):25-9. [Medline].

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Further Reading

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Keywords

herpes zoster ophthalmicus, eye infection, herpes zoster, varicella-zoster virus, varicella zoster virus, VZV, HZO, herpes virus, chickenpox, shingles, human herpesvirus type 3

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Contributor Information and Disclosures

Author

Maria M Diaz, MD, Staff Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center
Maria M Diaz, MD is a member of the following medical societies: Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Mark A Silverberg, MD, FACEP, MMB is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Robin R Hemphill, MD, MPH, Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University
Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Douglas Lavenburg, MD, Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems
Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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