Long term complications and vision loss following herpes zoster ophthalmicus (HZO)

Abstract

Purpose : To examine the long-term sequelae of HZO and risk factors for vision loss.

Methods : Retrospective review of all subjects with HZO seen between 1^st January 2006 and 31^st December 2016 at Auckland District Health Board. Moderate vision loss (MVL) was defined as ≤20/50 and severe vision loss (SVL) as ≤ 20/200.

Results : 869 subjects were included in the study with a median follow up of 6.3 years (total 5504.4 patient-years follow up). Median age was 65.5 years, 52.6% were male and 71.5% were Caucasian. Immunosuppression was present in 83 subjects (9.6%) and 102 subjects (11.7%) were diabetic. Conjunctivitis was present in 76.1%, corneal involvement in 445 subjects (51.2%) and uveitis in 413 subjects (47.6%). Cranial nerve palsy occurred in 30 subjects (3.5%), optic neuropathy in 15 subjects (1.7%) and proptosis in 3 subjects (0.3%). Systemic antiviral therapy was commenced in 765 subjects (88.0%) and was received within 72 hours of rash onset in 468 subjects (54.9%). Topical steroid was required in 437 subjects (50.4%). Corneal scar developed in 151 (15.4%), neurotrophic keratitis in 58 (6.7%), corneal melt in 22 (2.5%) and perforation in 5 (0.6%). Elevated intraocular pressure (≥24mmHg) occurred in 169 subjects (19.5%), but glaucoma only developed in 33 subjects (3.8%). 551 recurrences were observed during the study period, with at least one recurrence in 200 subjects (23.0%). Median final visual acuity was 6/7.5 (IQR 6/6 – 6/12). MVL occurred in 169 eyes (19.8%), of whom 83 (9.6%) were due to HZO. SVL occurred in 65 eyes (7.6%), of whom 31 (3.6%) were due to HZO. On multivariate analysis older age (HR 1.038 p<0.001), Caucasian ethnicity (HR 2.344 p=0.036), poor presenting visual acuity (HR 1.978 p=0.010) and uveitis (HR 3.882 p<0.001) were associated with increased risk of MVL due to HZO. For SVL due to HZO, significant risk factors on multivariate analysis were older age (HR 1.059 p=0.001), immunosuppression (HR 3.125 p=0.028), poor presenting visual acuity (HR 2.821 p=0.002) and uveitis (HR 4.777 p=0.004).

Conclusions : HZO is associated with a high rate of complications and vision loss. Older age, Caucasian ethnicity, poor presenting visual acuity and uveitis are risk factors for moderate vision loss.

This is a 2020 ARVO Annual Meeting abstract.