scholarly journals Severe Bilateral Photophobia and Unilateral Abducens Nerve Palsy: An Unusual Presentation of Herpes Zoster Ophthalmicus

2021 ◽  
pp. 543-547
Author(s):  
Ian Seddon ◽  
Keith Skolnick
Keyword(s):  
Herpes Zoster ◽  
Antiviral Treatment ◽  
Abducens Nerve ◽  
Corticosteroid Treatment ◽  
Unusual Presentation ◽  
Herpes Zoster Ophthalmicus ◽  
Varicella Zoster ◽  
Immune Mediated ◽  
Neurologic Sequelae ◽  
Systemic Glucocorticoids

Herpes zoster ophthalmicus (HZO) is an uncommon neurocutaneous condition resulting from reactivation of the varicella zoster virus in the ophthalmic division of the trigeminal nerve. Typical presentation of HZO includes a characteristic painful vesicular dermatomal rash. However, the appearance of isolated neurologic complications in the absence of ocular findings has not been previously emphasized. We observed a 47-year-old female patient with established HZO who presented with 1 week of worsening bilateral photophobia and double vision following completion of antiviral treatment. Her motility examination revealed near-complete abduction deficit of her left eye with no other signs of neurologic deficit. Slit lamp biomicroscopy, magnetic resonance imaging, and all laboratory tests were negative. After 2 tapering cycles of oral corticosteroid treatment, her photophobia resolved, and ophthalmoplegia significantly improved. The failure of antiviral therapy in preventing our patient’s neurologic sequelae highlights the importance of concurrent steroid therapy in suspected HZO patients. Furthermore, the resolution of symptoms following administration of systemic glucocorticoids supports consideration of HZO complications as immune-mediated. Finally, the unusual presentation of bilateral photophobia in the absence of ocular inflammation warrants further investigation into the pathogenesis of HZO.

scholarly journals Does Herpes Zoster Increase the Risk of Stroke and Myocardial Infarction? A Comprehensive Review

2019 ◽  
Vol 8 (4) ◽  
pp. 547 ◽  
Author(s):  
Ping-Hsun Wu ◽  
Yun-Shiuan Chuang ◽  
Yi-Ting Lin
Keyword(s):  
Myocardial Infarction ◽  
Herpes Zoster ◽  
Antiviral Treatment ◽  
Cardiac Events ◽  
Herpes Zoster Ophthalmicus ◽  
Varicella Zoster ◽  
Vesicular Rash ◽  
Ischemic Complications ◽  
One Year ◽  
Ischemic Attack

Herpes zoster (HZ) caused by varicella zoster virus (VZV) reactivation is characterized as a vesicular rash of unilateral distribution that can also cause multiple complications; such as post-herpetic neuralgia; ophthalmic zoster; and other neurological issues. VZV can also increase incident hemorrhagic or ischemic complications by causing inflammatory vasculopathy. Thus; emerging epidemiological and clinical data recognizes an association between HZ and subsequent acute strokes or myocardial infarction (MI). This study reviewed published articles to elucidate the association between HZ and cerebrovascular and cardiac events. Individuals exposed to HZ or herpes zoster ophthalmicus had 1.3 to 4-fold increased risks of cerebrovascular events. Higher risks were noted among younger patients (age < 40 years) within one year after an HZ episode. The elevated risk of CV events diminished gradually according to age and length of time after an HZ episode. The putative mechanisms of VZV vasculopathy were also discussed. Several studies showed that the development of herpes zoster and herpes zoster ophthalmicus increased the risks of stroke; transient ischemic attack; and acute cardiac events. The association between VZV infection and cardiovascular events requires further studies to establish the optimal antiviral treatment and zoster vaccination to reduce zoster-associated vascular risk

scholarly journals Effectiveness of Live Zoster Vaccine in Preventing Herpes Zoster Ophthalmicus (HZO)

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S413-S413 ◽  
Author(s):  
Laurie Aukes ◽  
Joan Bartlett ◽  
Bruce Fireman ◽  
John Hansen ◽  
Edwin Lewis ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Cox Regression ◽  
Age Groups ◽  
Weighted Average ◽  
Care Seeking ◽  
Zoster Vaccine ◽  
Herpes Zoster Ophthalmicus ◽  
Varicella Zoster ◽  
Grant Recipient ◽  
Restricted Stock

Abstract Background Herpes zoster ophthalmicus (HZO), caused by reactivation of varicella-zoster virus in or around the eye, can be severe and often results in care-seeking that may be less discretionary than for uncomplicated herpes zoster (HZ). We compared the vaccine effectiveness (VE) of live zoster vaccine against HZO with the VE against HZ overall. Methods Kaiser Permanente Northern California (KPNC) members enter the ongoing cohort study when age-eligible for zoster vaccine starting in 2007. Incident HZ was defined as a new diagnosis of HZ with an antiviral prescription or a positive varicella viral test. Among those, an HZO case was defined as having an HZO diagnosis during an ophthalmology visit within 30 days of the initial HZ diagnosis. VE by age at vaccination and time since vaccination was estimated using Cox regression adjusted for age, race, sex and time-varying measures of healthcare use, comorbidities and immunocompromise status. Average VE over the first 5 years following vaccination was calculated as a weighted average of annual VE estimates. Results During 2007–2014, ~1.3 million individuals ≥50 years of age entered the study population and 29% were vaccinated. Among 48,889 incident HZ cases, 2,858 (6%) had HZO, 87% of whom were unvaccinated. For all ages combined, VE against HZO was 72% (95% CI, 64%-79%) in year 1, similar to 68% (95% CI, 65%-70%) against HZ. VE fell in years 2, 3, 4, and 5 to 47%, 45%, 42% and 27% for HZO and to 47%, 39%, 41% and 37% for HZ. For age groups 60 – 69 and 70 – 79, where we have the most data, initial VE and waning were similar for HZO and HZ. Numbers of HZO cases for 50–59 year olds were too small to evaluate at this time. Average VE against HZO over the first 5 years following vaccination was 52% (95% CI, 42%–60%) for ages 60–69, 51% (95% CI, 39%–61%) for ages 70-79, and 39% (95% CI, 14%-57%) for ages 80+; similarly, 5-year average VE against HZ was 49%, 46%, and 44% for these 3 age groups. Conclusion VE against HZO was similar to VE against HZ regardless of age at vaccination or time since vaccination. Effectiveness of live zoster vaccine in preventing HZO was highest in year one with subsequent waning. Disclosures E. Earley, Merck & Co.: Research Contractor, Salary; M. Marks, Merck and Co. Inc.: Employee, Restricted Stock and Salary; P. Saddier, Merck & Co., Inc.: Employee, Salary; N. P. Klein, GSK: Investigator, Grant recipient; sanofi pasteur: Investigator, Grant recipient; Merck & Co.: Investigator, Grant recipient; MedImmune: Investigator, Grant recipient; Protein Science: Investigator, Grant recipient Pfizer: Investigator, Grant recipient

Herpes Zoster Ophthalmicus—Diagnosis and Management

2013 ◽  
Vol 06 (02) ◽  
pp. 1 ◽  
Author(s):  
Antoine Rousseau ◽  
Tristan Bourcier ◽  
Joseph Colin ◽  
Marc Labetoulle ◽  
◽  
...  
Keyword(s):  
Herpes Zoster ◽  
General Population ◽  
Viral Replication ◽  
Varicella Zoster Virus ◽  
Lifetime Risk ◽  
Herpes Zoster Ophthalmicus ◽  
Ocular Complications ◽  
Varicella Zoster ◽  
Diagnosis And Management

Varicella-zoster virus (VZV) infections are widely distributed in the general population. The lifetime risk of herpes zoster is estimated to be 10–20 %, increasing with age (1–4). Since herpes zoster ophthalmicus (HZO) accounts for 20 % of all locations of shingles, the lifetime risk of HZO is about 1–2 %. The management of ocular complications of VZV infection is now well codified, but sequellae still can occur, despite an armamentarium effective in limiting viral replication and its immune consequences.

scholarly journals A Pediatric Case of Relapsing-Remitting Multiple Sclerosis Onset following Varicella Zoster Ophthalmicus with Optic Neuritis

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Naoko Shiba ◽  
Yuji Inaba ◽  
Mitsuo Motobayashi ◽  
Makoto Nishioka ◽  
Yoichiro Kawasaki ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Herpes Zoster ◽  
Optic Neuritis ◽  
Trigeminal Nerve ◽  
Present Report ◽  
Epidemiological Studies ◽  
Herpes Zoster Ophthalmicus ◽  
Varicella Zoster ◽  
Relapsing Remitting ◽  
Relapsing Remitting Multiple Sclerosis

Some epidemiological studies have implied a pathogenetic association between varicella zoster virus (VZV) and multiple sclerosis (MS); this, however, remains controversial. The present report describes a case involving an immunocompetent 10-year-old girl who developed relapsing-remitting MS following the prolonged reactivation of VZV inside the first branch of the trigeminal nerve, exhibiting herpes zoster ophthalmicus with severe optic neuritis. Symptoms related to herpes zoster ophthalmicus and MS appeared consecutively in the 10-week period after the appearance of vesicles. This suggests that the onset of MS was triggered by some mechanism involving VZV reactivation in the first branch of the trigeminal nerve. To the best of our knowledge, this report is the first to describe a relationship between the onset of MS and herpes zoster ophthalmicus. Early diagnosis and aggressive antiviral therapy are important in cases of herpes zoster ophthalmicus to prevent the possible development of MS as well as visual impairment as sequela.

scholarly journals Human Vaccines and Herpes Zoster Ophthalmicus: Clinical Manifestation, Treatment, and Prevention

2020 ◽  
Vol 8 (F) ◽  
pp. 203-207
Author(s):  
Vina Yuwanda
Keyword(s):  
Herpes Zoster ◽  
Immunosuppressive Agents ◽  
Antibody Detection ◽  
Zoster Vaccine ◽  
Herpes Zoster Ophthalmicus ◽  
Varicella Zoster ◽  
Ocular Manifestations ◽  
Treatment And Prevention ◽  
Control And Prevention ◽  
Recombinant Zoster Vaccine

Herpes zoster ophthalmicus (HZO) is a reactivation of HZ virus that is latent in ophthalmic division of trigeminal ganglion. Patients over 50 years old, premature infant, pregnancy woman, receiving immunosuppressive agents, and malignancies are at risk of having HZO. Ocular manifestations of HZ are ectropion, entropion, ectopic eyelash, keratitis, conjunctivitis, symblepharon, hypoesthesia, episcleritis, scleritis, scleral atrophy and thinning, uveitis, iris atrophy, posterior synechiae, acute retinal necrosis, progressive outer retinal necrosis, retinal detachment, retina atrophy, optic neuritis, optic atrophy, and strabismus. Polymerase chain reaction, antigen detection, and antibody detection can help to confirm diagnosis. Pharmacology treatments for HZ ophthalmicus are antiviral drugs, corticosteroids, analgesics, tricyclic antidepressants, and antiepileptic drug. Non-pharmacology therapies are scleral contact lens, phototherapeutic keratectomy, photorefractive keratectomy, and penetrating keratoplasty. There are two kinds of vaccination which can be given to patients: Live-attenuated varicella zoster vaccine and recombinant zoster vaccine. It is recommended by Centers for Disease Control and Prevention and Food and Drugs Administration to use recombinant zoster vaccine by 50 years old.

Sign in / Sign up

Export Citation Format

Share Document