J Korean Ophthalmol Soc > Volume 58(12); 2017 > Article
Journal of the Korean Ophthalmological Society 2017;58(12):1317-1324.
DOI: https://doi.org/10.3341/jkos.2017.58.12.1317    Published online December 15, 2017.
Clinical Features and Risk Factors of Herpes Zoster Ophthalmicus.
Chi Young Mun, Moon Sun Jung
Department of Ophthalmology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea. inmydream@schmc.ac.kr
눈대상포진 환자의 임상양상 및 위험인자 분석
문치영ㆍ정문선
순천향대학교 의과대학 천안병원 안과학교실
Correspondence:  Moon Sun Jung,
Email: inmydream@schmc.ac.kr
Received: 13 July 2017   • Revised: 29 September 2017   • Accepted: 29 November 2017
Abstract
PURPOSE
To evaluate the clinical characteristics and risk factors of severe manifestation of herpes zoster ophthalmicus. METHODS: We conducted a retrospective analysis using medical records from 106 patients diagnosed with herpes zoster ophthalmicus from January 2012 to June 2015. Patients were classified according to the type and frequency of ophthalmologic manifestations. Patients with conjunctivitis, punctate keratitis, and pseudodendritic keratitis were classified into the mild group, whereas patients with deep stromal keratitis, endothelitis, scleritis, glaucoma, and extraocular muscle paralysis were classified into the severe group. The age, sex, severity, location of skin lesions, delayed time to treatment, the presence of Hutchinson's sign, and associated systemic diseases were compared between the groups. In addition, we investigated changes in vision, intraocular pressure, treatment duration, recurrence and the prevalence of postherpetic neuralgia. RESULTS: The incidence of conjunctivitis (47.2%), punctate keratitis (42.5%), pseudodendritic keratitis (12.2%), deep stromal keratitis (12.2%), endothelitis (15.1%), scleritis (18.9%), glaucoma (14.2%), and extraocular muscle (EOM) paralysis (4.7%) were observed in these patients. The group with mild disease included 70 cases with conjunctivitis, punctate keratitis and pseudodendritic keratitis. The severe group included 36 cases with deep stromal keratitis, endothelitis, scleritis, glaucoma and EOM palsy. Disease most often occurred in the distribution of the first branch of the trigeminal nerve, with no differences in the age or sex of patients in both groups. Severe manifestations were more common when a greater extent of the skin was involved, when Hutchinson's sign was present, or when treatment was significantly delayed. There were no significant differences between the two groups in recurrence or the presence of postherpetic neuralgia. CONCLUSION: Long-term treatment for herpes zoster opthalmicus is more likely to be required if severe manifestation of disease exists, such as widespread skin involvement, Hutchinson's sign, or a delay to the initiation of antiviral treatment. More active observation and treatment are required in such cases.
Key Words: Herpes zoster ophthalmicus;Hutchinson's sign;Ocular manifestation


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