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Herpes Zoster Eye Complications: Rates and Trends

      Abstract

      Purpose

      To provide population-based data on the risk, types, and outcomes of eye involvement in herpes zoster (HZ).

      Methods

      A cohort study based on review of the medical records of patients in whom HZ was diagnosed between January 1, 1980, and December 31, 2007, was performed. Herpes zoster was confirmed by the presence of the typical rash and symptoms or by laboratory testing, and eye involvement was confirmed by ophthalmologists’ evaluation. Information was collected on all eye diagnoses and on HZ eye-related visits, treatments, procedures, and outcomes.

      Results

      Of the 7370 individuals with HZ in any dermatome, 184 (2.5%) had eye involvement. The mean age of the 184 was 62.6 years, and 5 cases occurred in patients younger than 21. Overall, 6.5% (12) were immunosuppressed at the time of the eye complications. The rate of increase in HZ eye involvement was 23% by decade from 1980 to 2007. Common eye complications were keratitis (n=144, 76.2%), uveitis/iritis (n=88, 46.6%), and conjunctivitis (n=67, 35.4%). Recurrent keratitis and recurrent iritis/uveitis occurred in 6.9% (13) and 7.4% (14), respectively. Outcomes included 6 patients (3.3%) with new vision decrements to 20/200 or worse. Two individuals had successful corneal transplants. Another 6 individuals (3.3%) had lid ptosis that affected vision, including 1 elderly woman with permanent unilateral tarsorrhaphy. Severe HZ eye pain was reported to be directly responsible for 1 unsuccessful suicide attempt. Acute retinal necrosis did not develop in any individual. A mean of 10.8 eye visits per patient with HZ and eye involvement was reported to continue for a mean of 308 days.

      Conclusion

      Eye complications are common and result in considerable health care use and permanent vision decrement in about 6.6% (6) of individuals with HZ eye involvement. Most health care use and long-term adverse outcomes occurred in patients in whom prevention of HZ with the zoster vaccine would be possible.

      Abbreviations and Acronyms:

      ARN (acute retinal necrosis), HIV (human immunodeficiency virus), HZ (herpes zoster), HZO (herpes zoster ophthalmicus), REP (Rochester Epidemiology Project), VZV (varicella-zoster virus)
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      • Correction
        Mayo Clinic ProceedingsVol. 92Issue 9
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          In the article titled, “Herpes Zoster Eye Complications: Rates and Trends,” published in the June 2013 issue of Mayo Clinic Proceedings (Mayo Clin Proc. 2013;88(6):562-570), there are errors in the Results section of the abstract, the first sentence of the Results section, and the Conclusion due to an incorrect denominator. The first sentence of the Results section of the abstract should read: Of the 2035 individuals with HZ in any dermatome, 184 (9.0%) had eye involvement. The first sentence of the Results section should read: Of the 2035 patients with confirmed HZ, 184 had 189 episodes of HZ with eye involvement between January 1, 1980, and December 31, 2007.
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