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Herpes Simplex and Herpes Zoster Eye Disease: Presentation and Management at a City Hospital for the Underserved in the United States

Edell, Aimée R. P. M.D.; Cohen, Elisabeth J. M.D.

doi: 10.1097/ICL.0b013e31829a3b47

Objective: To further define the spectrum of clinical disease and treatment among patients with herpes zoster ophthalmicus (HZO) and ocular herpes simplex viral (HSV) infection presenting at a large city hospital for the underserved in the United States.

Methods: Retrospective review of medical records of 64 patients (40 HZO and 24 ocular HSV infection) presenting to the Bellevue Hospital Emergency Department for the management of herpetic eye disease for which an ophthalmologic consultation was obtained from January 1, 2006, to December 31, 2011.

Results: The mean age of patients with HZO was 51 ± 15 years (n=40) versus 33 ± 16 years for patients with ocular HSV infection (n=24; P<0.0001). Overall, 73% of patients with HZO were aged <60 years (n=29 of 40), of whom, 90% (26 of 29) were immunocompetent. The most common decade of onset of HZO was 50 to 59 years (11 of 40, 28%). Four patients with HZO were immunocompromised (n=4 of 40; 10%), with 3 aged <60 years attributable to human immunodeficiency virus (n=3 of 29, 10%). The study included 12 patients eligible to receive the herpes zoster vaccine. None of these patients had a history of vaccination. Of the 24 patients with ocular HSV infection, corneal stromal disease was present in 7 patients and infectious epithelial keratitis in 10 patients. No patients were treated with long-term oral antiviral prophylaxis.

Conclusions: Acute HZO was seen more commonly than ocular HSV infection. Patients with HZO were significantly older than those with ocular HSV infection. Available prevention modalities, such as the vaccine against herpes zoster and long-term oral antiviral therapy to reduce ocular HSV infection recurrence, were underused.

Department of Ophthalmology (A.R.P.E., E.J.C.), New York University School of Medicine, New York, NY.

Address correspondence and reprint requests to Elisabeth J. Cohen, M.D., 33 E. 70th Street Apt 6 D, New York, NY 10021; e-mail:

The authors have no funding or conflicts of interest to disclose.

Accepted April 15, 2013

© 2013 Contact Lens Association of Ophthalmologists, Inc.