HERPES ZOSTER OPHTHALMICUS: A CASE OF BLINDING KERATITIS
Hajar Adani A., Juanarita J., Azreen Redzal A. & Ropilah A.R.
abstract
We report a case of herpes zoster ophthalmicus (HZO) in a 66-year-old Malay lady with underlying diabetes mellitus, hypertension, and dyslipidemia, who presented with left forehead blisters consistent with HZO. Initial management was suboptimal, as she sought traditional treatment. Progressive scarring led to left upper eyelid scarring and defect, leading to exposure of the cornea. Despite surgical repair and medical therapy, she developed neurotrophic keratitis and subsequent mixed bacterial-fungal superinfection (Enterococcus faecalis and Pichia species) in the left eye. Aggressive topical antimicrobial treatment was initiated, and repeat lid surgery was planned. Herpes zoster ophthalmicus can lead to severe ocular sequelae, particularly in immunocompromised or systemically unwell patients. Early diagnosis and coordinated medical-surgical management are essential to minimize complications such as neurotrophic keratopathy and secondary infection.
references
1. Liesegang TJ. Herpes zoster ophthalmicus natural history, risk factors, clinical presentation, and morbidity. Ophthalmology. 2008 Feb;115(2 Suppl):S3-12. [PubMed].
2. Kong CL, Thompson RR, Porco TC, Kim E, Acharya NR. Incidence Rate of Herpes Zoster Ophthalmicus: A Retrospective Cohort Study from 1994 through 2018. Ophthalmology. 2020 Mar;127(3):324-330.
3. Meyer JJ,Liu K, McGhee CNJ, Danesh-Meyer HV, Niederer RL, (2022) Neurotrophic Keratopathy after Herpes Zoster Ophthalmicus, Cornea.2022 41(11): 1433-143.
4. Kalogeropoulos CD, Bassukas ID, Moschos MM, Tabbara KF. Eye and Periocular Skin Involvement in Herpes Zoster Infection. Med Hypothesis Discov Innov Ophthalmol. 2015 Winter;4(4):142-156.
5. Hoeksema L, Jansonius NM, Los LI. Risk Factors for Secondary Glaucoma in Herpetic Anterior Uveitis. Am J Ophthalmol. 2017 Sep;181:55-60.
6. Chua JV, Chen WH. Herpes zoster vaccine for the elderly: boosting immunity. Aging health. 2010 Apr 01;6(2):169-176.
7. Taariq K Mohammed, Elisabeth J Cohen, Bennie H Jeng. A Review of Treatment for Herpes Zoster Keratitis. Touch review in Ophthalmology. 2021;15(2):43-45 DOI: https://doi.org/10.17925/USOR.2021.15.2.43.
2. Kong CL, Thompson RR, Porco TC, Kim E, Acharya NR. Incidence Rate of Herpes Zoster Ophthalmicus: A Retrospective Cohort Study from 1994 through 2018. Ophthalmology. 2020 Mar;127(3):324-330.
3. Meyer JJ,Liu K, McGhee CNJ, Danesh-Meyer HV, Niederer RL, (2022) Neurotrophic Keratopathy after Herpes Zoster Ophthalmicus, Cornea.2022 41(11): 1433-143.
4. Kalogeropoulos CD, Bassukas ID, Moschos MM, Tabbara KF. Eye and Periocular Skin Involvement in Herpes Zoster Infection. Med Hypothesis Discov Innov Ophthalmol. 2015 Winter;4(4):142-156.
5. Hoeksema L, Jansonius NM, Los LI. Risk Factors for Secondary Glaucoma in Herpetic Anterior Uveitis. Am J Ophthalmol. 2017 Sep;181:55-60.
6. Chua JV, Chen WH. Herpes zoster vaccine for the elderly: boosting immunity. Aging health. 2010 Apr 01;6(2):169-176.
7. Taariq K Mohammed, Elisabeth J Cohen, Bennie H Jeng. A Review of Treatment for Herpes Zoster Keratitis. Touch review in Ophthalmology. 2021;15(2):43-45 DOI: https://doi.org/10.17925/USOR.2021.15.2.43.