Herpes Zoster Ophthalmicus

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The herpes zoster virus causes herpes zoster ophthalmicus. This virus is a varicella-type virus that can lie dormant and then reactivate when there is a decrease in the immune system’s abilities.

Signs and Symptoms

Some of the signs typically associated with HZO include the following:

  • Fever
  • Facial pain
  • General malaise
  • A skin rash that will have discharge and then scab over

In some patients, keratitis, conjunctivitis, ocular cranial-nerve palsy or uveitis may occur.


According to the Handbook of Ocular Disease Management, one thing a diagnosing ophthalmologist must consider is that “the dendritic keratitis which occurs in HZO in infiltrative, while the HSV dendrites are ulcerative.” (HSV refers to herpes simplex virus)


In some patients, a debilitating complication called postherpetic neuralgia (PHN) may occur. This is one of several complications that may result from HZO, and it is also the most common. Optic neuritis is documented to have appeared in approximately 1 in 400 cases. It may occur after a patient develops HZO. Other complications with HZO revolve around the retina and optic nerve.


Treatment includes the use of antiviral medications. These are most effective when given within 72 hours of rash onset.


The zoster vaccine can prevent many cases of HZO, along with herpes zoster (HZ) and PHN.

Risk Factors

It is estimated that 10 percent to 20 percent of the 20 percent to 30 percent of people who get herpes zoster in their lifetime will develop herpes zoster ophthalmicus (HZO).

According to the Handbook of Ocular Disease Management, those who are over the age of 70 have a higher risk for HZO infection. People with immune-system compromise from AIDS, Lyme disease, lymphoma and other conditions are also at a higher risk.


Evaluation and Management of Herpes Zoster Ophthalmicus. Saad Shaikh, MD and Christopher N. Ta, MD. American Family Physician. November 1, 2002. https://www.aafp.org/afp/20021101/1723.html

Herpes Zoster Ophthalmicus. Handbook of Ocular Disease Management. Johnson Publishing, LLC. https://www.revoptom.com/handbook/sect1F.htm

Herpes zoster Ophthalmicus natural history, risk factors, clinical presentation, and morbidity. TJ Liesegang. Ophthalmology. February 2008; 115 (2 Suppl): S3-12. https://www.ncbi.nlm.nih.gov/pubmed/18243930