Ocular complications of herpes zoster ophthaimicus and post herpetic neuralgia A clinical study

Abstract

Background: Herpes Zoster Ophthalmicus (HZO) affects the eye and adenexa and is often associated with severe ocular morbidity and neuralgic pain. It primarily affects the elderly and immunosuppressed people. Atypical clinical manifestations are more likely to occur in HIV positive patients than in immunocompetent individuals. Post herpetic neuralgia (PHN) forms one of the most chronic and distressing non-ocular complication of HZO. Objectives: To determine the spectrum of ocular complications, factors influencing visual prognosis, the effect of HIV-AIDS on the spectrum of ocular complications and the spectrum of post herpetic neuralgia in patients with Herpes Zoster OphthaImicus. Materials and Methods: In this prospective interventional study, all patients who presented to the Department of Ophthalmology branch within 3 weeks of the onset of active zoster-vesicle formation affecting the ophthalmic of the trigeminal nerve were included. Patients with post herpetic neuralgia were referred to the Department of Neuropsychiatry. Patients with pre-existing ocular disorders were excluded from the study. Results: The most common predisposing condition seen in this study was HIV infection, w h i c h w a s s e e n i n 4 4 . 2 % ( 1 9 / 43) of the patients. A peak incidence was seen in the age group, between 21-60 years. A positive Hutchinson's sign correlated significantly with the ocular manifestations of decreased corneal sensation, acute corneal lesions and uveitis. Corneal involvement was seen in 95.3% (41/ 43). Uveitis was seen in 44.2% (19/43) of the patients. The visual outcome in most of the patients was good with maximum patients having no visual loss. Acute herpetic pain was seen in 97.7% (42/43) patients. Postherpetic neuralgia was seen in 41.9% (18/43) patients. About 53% of the patients had no visual loss at 6 months follow-up, while 27.9% had mild-moderate visual loss and only 13.9% had severe visual loss There were only 6 patients who had severe visual loss. Conclusion: HZO is more frequently presenting at a younger age, due to an increasing incidence of HIV AIDS. Patients wi t h n a s o c i l i a r y a n d l a c r i m a l n e r v e involvement and the presence of Hutchison's sign are more likely to have serious ocular complications. Visual loss is more likely in this group, warranting close follow-up and prompt treatment. The spectrum of ocular complications in immunosuppressed did not significantly differ from the immunocompetent patients. The overall good outcome in this study is due to the u se of early intensive antiviral therapy.