Herpes Zoster Optic Neuropathy

Authors

Aaron R. Kaufman, Boston University School of Medicine (ARK), Boston, Massachusetts; Department of Ophthalmology (EMM, KCG), University of Cincinnati, Cincinnati Eye Institute, Cincinnati, Ohio; Neuro-Ophthalmology Service (MLM), Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; and Department of Ophthalmology (JS, LBK), University of Alabama School of Medicine, Birmingham, Alabama.
Eileen M. Myers
Mark L. Moster
Jordan Stanley
Lanning B. Kline
Karl C. Golnik

Document Type

Article

Abstract

BACKGROUND: Herpes zoster optic neuropathy (HZON) is a rare manifestation of herpes zoster ophthalmicus (HZO). The aim of our study was to better characterize the clinical features, therapeutic choices, and visual outcomes in HZON. METHODS: A retrospective chart review was performed at multiple academic eye centers with the inclusion criteria of all eyes presenting with optic neuropathy within 1 month of cutaneous zoster of the ipsilateral trigeminal dermatome. Data were collected regarding presenting features, treatment regimen, and visual acuity outcomes. RESULTS: Six patients meeting the HZON inclusion criteria were identified. Mean follow-up was 2.75 months (range 0.5-4 months). Herpes zoster optic neuropathy developed at a mean of 14.1 days after initial rash (range 6-30 days). Optic neuropathy was anterior in 2 eyes and retrobulbar in 4 eyes. Other manifestations of HZO included keratoconjunctivitis (3 eyes) and iritis (4 eyes). All patients were treated with systemic antiviral therapy in addition to topical and/or systemic corticosteroids. At the last follow-up, visual acuity in 3 eyes had improved relative to presentation, 2 eyes had worsened, and 1 eye remained the same. The 2 eyes that did not receive systemic corticosteroids had the best observed final visual acuity. CONCLUSION: Herpes zoster optic neuropathy is an unusual but distinctive complication of HZO. Visual recovery after HZON is variable. Identification of an optimal treatment regiment for HZON could not be identified from our patient cohort. Systemic antiviral agents are a component of HZON treatment regimens. Efficacy of systemic corticosteroids for HZON remains unclear and should be considered on a case-by-case basis.

Medical Subject Headings

Adult; Aged; Antiviral Agents (therapeutic use); Drug Therapy, Combination; Female; Follow-Up Studies; Glucocorticoids (therapeutic use); Herpes Zoster Ophthalmicus (diagnosis, drug therapy, physiopathology, virology); Herpesvirus 3, Human (isolation & purification); Humans; Male; Middle Aged; Optic Nerve Diseases (diagnosis, drug therapy, physiopathology, virology); Retrospective Studies; Visual Acuity (physiology)

Publication Date

6-1-2018

Publication Title

Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society

E-ISSN

1536-5166

Volume

38

Issue

2

First Page

179

Last Page

189

PubMed ID

29266031

Digital Object Identifier (DOI)

10.1097/WNO.0000000000000607

Recommended Citation

Kaufman, Aaron R.; Myers, Eileen M.; Moster, Mark L.; Stanley, Jordan; Kline, Lanning B.; and Golnik, Karl C., "Herpes Zoster Optic Neuropathy" (2018). Neurology. 1571.
https://scholar.barrowneuro.org/neurology/1571