Original articleHerpes Zoster Eye Complications: Rates and Trends
Section snippets
Methods
This cohort study of all patients in Olmsted County, Minnesota, with a confirmed diagnosis of HZ from 1980 to 2007 was performed by reviewing medical records. The results reported are the rates of HZ affecting the eye, including physician-documented type of eye involvement, duration of complications, health care use for HZO, and procedures associated with HZ eye complications.
Results
Of the 7370 patients with confirmed HZ, 184 had 189 episodes of HZ with eye involvement between January 1, 1980, and December 31, 2007. One individual had 2 episodes during the period, and 2 patients had 3 separate episodes of HZ with eye involvement during the study period.
The 184 affected individuals included 107 women (58.2%) and 77 men (41.8%). This was similar to the overall sex distribution of the HZ cases during this time (58.6% [n=4319] of women and 41.4% [n=3051] of men; P=.95). The
Discussion
Herpes zoster eye complications were common during this 28-year period, and incidence rates of eye complications in individuals with HZ increased 23% between 1980 and 2007. Health care use was extensive for HZ eye complications, with an average of more than 8 visits over a 6-month or longer period. One in 15 people with eye complications underwent 1 or more eye procedures directly related to HZ. One in 10 patients had recurrences or the onset of keratitis or uveitis delayed for 4 or more weeks
Conclusion
Herpes zoster eye complications affected approximately 2.5% of this group of individuals studied in Olmsted County. HZ eye complications are associated with major patient and health care service–use burdens. If this rate is applied to the nearly 1 million new HZ cases occurring each year in the United States, approximately 25,000 HZ eye complications also develop per year. The rates are increasing, and outcomes, though usually good, can result in prolonged requirements for medical eye care and
References (62)
- et al.
A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction
Mayo Clin Proc
(2007) Herpes zoster: epidemiology, natural history, and common complications
J Am Acad Dermatol
(2007)- et al.
What does epidemiology tell us about the risk factors for HZ?
Lancet Infect Dis
(2004) - et al.
Healthcare utilization and cost burden of herpes zoster in a community population
Mayo Clin Proc
(2009) - et al.
Herpes zoster burden of illness and health care resource utilization in the Australian population aged 50 years and older
Vaccine
(2009) Herpes zoster ophthalmicus natural history, risk factors, clinical presentation, and morbidity
Ophthalmology
(2008)- et al.
Herpes zoster ophthalmicus: comparison of disease in patient 60 years and older versus younger than 60 years
Ophthalmology
(2011) Anterior segment complications of herpes zoster ophthalmicus
Ophthalmology
(2008)- et al.
Images in emergency medicine. Herpes zoster ophthalmicus with ocular involvement
Ann Emerg Med
(2008) - et al.
Non-necrotizing herpetic vasculitis
Ophthalmology
(2009)
Generalizability of epidemiological findings and public health decisions: an illustration from the Rochester Epidemiology Project
Mayo Clin Proc
History of the Rochester Epidemiology Project: half a century of medical records linkage in a US population
Mayo Clin Proc
History of the Rochester Epidemiology Project
Mayo Clin Proc
Non-necrotizing herpetic vasculitis
Ophthalmology
Boston keratoprosthesis treatment of herpes zoster neurotrophic keratopathy
Ophthalmology
The incidence of herpes zoster
Arch Intern Med
Clinical practice. Herpes zoster
N Engl J Med
Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United Kingdom
Epidemiol Infect
Population-based study of herpes zoster and its sequelae
Medicine (Baltimore)
Herpes zoster and quality of life: a self-limited disease with severe impact
Neurology
[Herpes zoster and post-herpetic neuralgia in older adults.]. [in French]
Rev Med Suisse
Clinical and psychosocial correlates of post-herpetic neuralgia
J Med Virol
Prevalence of postherpetic neuralgia after a first episode of herpes zoster: prospective study with long term follow up
BMJ
Postherpetic neuralgia: the importance of preventing this intractable end-stage disorder
J Infect Dis
Increased risk of anterior uveitis following herpes zoster: a nationwide population-based study
Arch Opthalmol
Herpes zoster ophthalmicus in Olmsted County, Minnesota: have systemic antivirals made a difference?
Arch Ophthalmol
Triaging herpes zoster ophthalmicus patients in the emergency department: do all patients require referral?
Acad Emerg Med
Visual prognosis in immunocompetent patients with herpes zoster ophthalmicus
Acta Ophthalmol Scand
Ophthalmoplegia secondary to herpes zoster ophthalmicus
BMJ Case Rep
Herpes zoster ophthalmicus: disease spectrum in young adults
Middle East Afr J Ophthalmol
Ocular manifestations in herpes zoster ophthalmicus
Nepal J Ophthalmol
Cited by (119)
Herpes zoster ophthalmicus: frequency and risk factors for developing uncommon ocular manifestations
2023, Canadian Journal of OphthalmologyEye-on-a-chip
2023, Principles of Human Organs-on-ChipsVaricella-zoster virus infection presenting with unilateral keratouveitis and papillitis in an immunocompetent adult
2022, Photodiagnosis and Photodynamic TherapyCitation Excerpt :Reactivation of the varicella-zoster virus (VZV) residing in the ophthalmic nerve due to a compromise in the host's immune status or other triggering conditions cause herpes zoster ophthalmicus (HZO) disease. Anterior segment manifestations include conjunctival hyperemia, chemosis, punctate epithelial keratitis, pseudodendritis, endotheliitis, corneal ulceration, corneal scarring, iris atrophy, and cataract [1]. Rarely, posterior segment complications including ischemic optic neuropathy, optic neuritis, and central retinal artery/vein occlusion can also occur in HZO [2,3].
Colombian Ocular Infectious Epidemiology Study (COIES): Herpes Zoster Ophthalmicus prevalence and sociodemographic characterization, 2015-2019
2022, International Journal of Infectious DiseasesEffectiveness of the Recombinant Zoster Vaccine for Herpes Zoster Ophthalmicus in the United States
2021, OphthalmologyCitation Excerpt :Herpes zoster ophthalmicus has a wide variety of complications that can be acute, chronic, or recurrent.6,9 The most common complication is postherpetic neuralgia, and the most common ocular manifestations are keratitis, uveitis, and conjunctivitis.8,9 More rarely, HZO can involve the optic nerve, retina, or central nervous system.6
Grant Support: Support for this investigator-initiated work was provided by Merck, Inc, based on an investigator-initiated application, and by the Rochester Epidemiology Project (grant number R01-AG034676: Principal Investigators, Walter A. Rocca, MD, and Barbara P. Yawn, MD, MSc).