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Herpes Zoster Optic Neuropathy

Kaufman, Aaron, R., BA; Myers, Eileen, M., MD; Moster, Mark, L., MD; Stanley, Jordan, MD; Kline, Lanning, B., MD; Golnik, Karl, C., MD, MEd

Journal of Neuro-Ophthalmology: June 2018 - Volume 38 - Issue 2 - p 179–189
doi: 10.1097/WNO.0000000000000607
Original Contribution

Background: Herpes zoster optic neuropathy (HZON) is a rare manifestation of herpes zoster ophthalmicus (HZO). The aim of our study was to better characterize the clinical features, therapeutic choices, and visual outcomes in HZON.

Methods: A retrospective chart review was performed at multiple academic eye centers with the inclusion criteria of all eyes presenting with optic neuropathy within 1 month of cutaneous zoster of the ipsilateral trigeminal dermatome. Data were collected regarding presenting features, treatment regimen, and visual acuity outcomes.

Results: Six patients meeting the HZON inclusion criteria were identified. Mean follow-up was 2.75 months (range 0.5–4 months). Herpes zoster optic neuropathy developed at a mean of 14.1 days after initial rash (range 6–30 days). Optic neuropathy was anterior in 2 eyes and retrobulbar in 4 eyes. Other manifestations of HZO included keratoconjunctivitis (3 eyes) and iritis (4 eyes). All patients were treated with systemic antiviral therapy in addition to topical and/or systemic corticosteroids. At the last follow-up, visual acuity in 3 eyes had improved relative to presentation, 2 eyes had worsened, and 1 eye remained the same. The 2 eyes that did not receive systemic corticosteroids had the best observed final visual acuity.

Conclusion: Herpes zoster optic neuropathy is an unusual but distinctive complication of HZO. Visual recovery after HZON is variable. Identification of an optimal treatment regiment for HZON could not be identified from our patient cohort. Systemic antiviral agents are a component of HZON treatment regimens. Efficacy of systemic corticosteroids for HZON remains unclear and should be considered on a case-by-case basis.

Boston University School of Medicine (ARK), Boston, Massachusetts; Department of Ophthalmology (EMM, KCG), University of Cincinnati, Cincinnati Eye Institute, Cincinnati, Ohio; Neuro-Ophthalmology Service (MLM), Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; and Department of Ophthalmology (JS, LBK), University of Alabama School of Medicine, Birmingham, Alabama.

Address correspondence to Karl C. Golnik, MD, MEd, Cincinnati Eye Institute, University of Cincinnati, 1945 CEI Drive, Cincinnati, OH 45242; E-mail:

Presented as poster “Herpes Zoster Optic Neuropathy in Patients With Herpes Zoster Ophthalmicus” at the 2016 American Academy of Ophthalmology Annual Meeting, October 15–18, 2016; Chicago, IL.

The authors report no conflicts of interest.

© 2018 by North American Neuro-Ophthalmology Society