Herpes zoster ophthalmicus (HZO) is reactivation of a varicella zoster virus infection (shingles) involving the eye. In the acute phase, patients present with a dermatomal forehead rash and severe pain around the infected area. Inflammation of anterior segment tissues and, less commonly, posterior structures of the eye are potential complications. Herpes zoster virus is considered the offending agent in most cases of acute retinal necrosis.
Early treatment (within 72 hours of symptom onset) with oral antiviral medications, such as valacyclovir, greatly reduces the risk of developing postherpetic neuralgia. Keratitis is treated with topical corticosteroids. For inflammation of the retina, intravenous antiviral medications are given and a hospital stay may be necessary.
In the United States, 30.9 out of every 100,000 people will develop herpes zoster ophthalmicus.
The shingles vaccine reduces the risk of varicella zoster reactivation, and current guidelines recommend vaccinating at age 60. However, researchers at Mass. Eye and Ear found that the incidence of HZO is increasing, while the age of onset is decreasing – from 60 years old in 2007 to 56 years old in 2013.3 These data strengthen the recommendation to vaccinate patients at 50 years of age. Caution is advised in patients with a moderate or severe acute illness, including an active or recent HZO infection.
Should patients be vaccinated for shingles before age 60?
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Zoster Eye Disease Study at Mass. Eye and Ear
With one of the largest herpes zoster ophthalmicus patient populations in the country – Mass. Eye and Ear is a participating site for the Zoster Eye Disease Study (ZEDS). This clinical trial will evaluate whether prolonged suppressive oral antiviral treatment with valacyclovir reduces complications of herpes zoster ophthalmicus.
Principal Investigator: James Chodosh, MD, MPH
Funded by: National Eye Institute
Patient enrollment begins in 2017
For more information, contact:
Xiao-Hong_Wen@meei.harvard.edu
Ask an Expert
If a patient has ocular complications from shingles, should they receive the shingles vaccine?
Anecdotal evidence suggests that patients with any form of ocular inflammation from shingles, for example zoster keratitis, may experience worsening of their eye condition soon after receiving the vaccine. Therefore, in the absence of clinical trial level evidence to the contrary, I advise my patients with active or recent ocular inflammation from shingles to avoid the vaccine.
James Chodosh, MD, MPH
Associate Director, Harvard Ophthalmology Infectious Disease Institute
Associate Director, Cornea and Refractive Surgery Service, Mass. Eye and Ear
3. Herpes zoster ophthalmicus: declining age at presentation. Davies EC, Pavan-Langston D, Chodosh J. Br J Ophthalmol. 2016 Mar;100(3):312-4.