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Reactivation of Herpes Zoster Keratitis in an Adult After Varicella Zoster Vaccination

Hwang, Charles W. Jr BS; Steigleman, Walter A. MD; Saucedo-Sanchez, Erika MD; Tuli, Sonal S. MD

doi: 10.1097/ICO.0b013e318277acae
Case Report

Purpose: In this study, the case of a patient who presented with reactivation of herpes zoster (HZ) keratitis and worsening of neurotrophic keratopathy, keratouveitis, and keratoconjunctivitis sicca after vaccination with live attenuated HZ vaccine (Zostavax) is described.

Method: This is a retrospective case review.

Results: A 63-year-old man, with a history of HZ keratouveitis and neurotrophic keratopathy that had been quiescent for 3.5 years off medication, presented with keratouveitis 2 weeks after Zostavax administration. Oral acyclovir and topical prednisolone acetate and cyclopentolate were started, with subsequent improvement in inflammation and visual acuity. However, the patient was unable to be tapered completely off the steroids.

Conclusions: HZ keratouveitis is the result of cell-mediated immunity (CMI) directed toward viral antigens within the eye. The live attenuated HZ vaccine, Zostavax, boosts the recipient’s CMI to prevent reactivation of HZ. However, patients with a history of HZ keratitis may have persistent viral antigens in their corneas and can develop recurrence of keratouveitis because of the vaccine-induced increase in CMI. Vaccination should be undertaken with caution in patients with a history of HZ ophthalmicus.

Department of Ophthalmology, University of Florida, Gainesville, FL. The current affiliation for Dr. Saucedo-Sanchez is the California Eye Professionals Medical Group, Menifee, CA.

Reprints: Sonal S. Tuli, Department of Ophthalmology, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610-0284 (e-mail:

Supported in part by an unrestricted grant from Research to Prevent Blindness and by National Eye Institute Grant P30-EY021721.

The authors report no conflicts of interest concerning the materials or methods used in the findings specified in this article.

Walter A. Steigleman is a military service member. This work was prepared as part of his official duties. Title 17, USC, §105 provides that “Copyright protection under this title is not available for any work of the U.S. Government.” Title 17, USC, §101 defines a US government work as a work prepared by a military service member or an employee of the US government as part of that person’s official duties. The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or US government.

Received June 16, 2012

Accepted October 04, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.