Original article
Herpes Zoster Eye Complications: Rates and Trends

https://doi.org/10.1016/j.mayocp.2013.03.014Get rights and content

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.

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

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    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).

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