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Herpes Zoster Stromal Keratitis After Varicella Vaccine Booster in a Pediatric Patient

Krall, Peter MD; Kubal, Anup MD

doi: 10.1097/ICO.0000000000000199
Case Report

Purpose: In this study, the case of a healthy pediatric patient who presented with herpes zoster (HZ) stromal keratitis after vaccination with live attenuated varicella vaccine (Varivax) and subsequent booster is described.

Method: This is a retrospective case review.

Results: A 6-year-old girl with no medical history presented with HZ ophthalmicus and stromal keratitis. She had received the original Varivax vaccine at 1 year of age and a booster 1 year before presentation. Topical prednisolone acetate was started with subsequent improvement in inflammation and visual acuity. However, the patient was unable to be completely tapered off the steroids because of reactivation.

Conclusions: HZ ophthalmicus with stromal keratitis is a rare but potentially damaging manifestation of the varicella zoster virus in the pediatric population. Long-term data regarding reactivation rates in the post-vaccination era are still limited. Close follow-up is needed to ensure resolution of the infiltrates, and reactivation may require long-term steroid therapy.

Department of Ophthalmology, University of Florida, Gainesville, FL.

Reprints: Peter Krall, MD, 7651 SW 87th Terrace, Gainesville, FL 32608 (e-mail:

Supported in part by an unrestricted grant from Research to Prevent Blindness.

The authors have no conflicts of interest to disclose.

Received March 03, 2014

Accepted June 02, 2014

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.