Overview
Herpes zoster ophthalmicus (HZO) is an ophthalmic complication of varicella-zoster virus reactivation, typically affecting the ophthalmic division of the trigeminal nerve, leading to ocular and systemic manifestations including vasculitis and potential intracranial complications 12.Diagnosis
Clinical presentation includes dermatomal rash, ocular pain, and potential neurological deficits 12.
Imaging (CT, MRI) and angiography may reveal vascular abnormalities such as mycotic aneurysms or occlusions 1.
Temporal artery biopsy can confirm vasculitis, though viral particles may not always be identified 2.Management
Antiviral therapy: Initiate early with acyclovir (70 mg/kg/day IV for 7-14 days or oral formulations as clinically appropriate) 12.
Adjunctive corticosteroids may be considered for severe cases to reduce inflammation, though evidence varies 12.
Supportive care including ophthalmological intervention for ocular complications 12.Special Populations
Immunocompromised hosts: Increased risk of severe complications including CNS involvement; closer monitoring and potentially prolonged antiviral therapy is advised 1.
Elderly: Higher susceptibility to HZO with greater likelihood of systemic complications such as vasculitis and mycotic aneurysms 1.Key Recommendations
Initiate antiviral therapy promptly in suspected cases of herpes zoster ophthalmicus to prevent progression and complications (Evidence: Moderate) 12.
Consider temporal artery biopsy in cases with delayed neurological deficits to confirm vasculitis, despite potential absence of viral particles on electron microscopy (Evidence: Weak) 2.
Monitor immunocompromised patients closely due to increased risk of severe complications including intracranial vascular events (Evidence: Expert opinion) 1.References
1 O'Donohue JM, Enzmann DR. Mycotic aneurysm in angiitis associated with herpes zoster ophthalmicus. AJNR. American journal of neuroradiology 1987. link
2 Victor DI, Green WR. Temporal artery biopsy in herpes zoster ophthalmicus with delayed arteritis. American journal of ophthalmology 1976. link90552-3)