Clinical Evaluation of Zoster Ophthalmicus

ABSTRACT

Herpes zoster is a localized vesicular eruption limited to the dermatome of a singl spinal or cranial sensory nerve. It is thought that the varicella-zoster virus enters the sensory nerve ending during the course of chickenpox and spreads up to theganglion and remains there in a latent state. If immunity is impaired, the virus replicates and migrates along sensory nerves to the skin or eye causing the lesins of zoster. The ophthalmic branch of the trigeminal nerve can be affected in the zoster patients. If ocular involvement occurs in association with a varicella-zoster infection of the ophthalmic branch of the trigeminal nerve, a number of clinical changes may take place in the eye and adnexa. Therefore, authors analyzed 320 cases of the herpes zoster patients who had visited Chon Buk National University Hospital from 1981 to 1986. The results were as follows 1. The sex distribution was 149(46.6%) male patients and 171(54.4%) females. 2. The peak incidence was in the 6th decades. 3. Thoracic nerve was involved in 134(41.9%) patients, lumbosacral in 65(20.3%), ophthalmic division of the trigeminal nerve in 59(18.4%), other trigeminal nerve, in 59(18.4%), and cervical in 28(8.8%). 4. 36 patients were associated with systemic diseases tuberculosis in 12, diabetis mellitus in 8, steroid therapy for arthritis in 6, hepatitis in 5, malignancy in 4, physical trauma in 2, CO poisoning in 1, and chronic renal failure in 1. 5. Zoster ophthalmicus patients were 32 among 59 involved in ophthalmic division of the trigeminal nerve. 6. The ocular leions were conjunctivities in 27(84.4%), keratitis in 13(40.6%), iritis in 10(31.3%), scleritis and episc1eritis in 9(28.1%), ptosis in 9(28.1%), and pupil distortion in 5(15.6%). 7. Complications and sequelae ensued in 23 patients corneal opacity in 8, lid scar with retraction in 7, chronic ptosis in 3, post-herpetic neuralgia in 2, iris atrophy in 2, and chronic glauooma in 1.