Neurological and Ophthalmological Manifestations of Varicella Zoster Virus
- 1 June 2019
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Neuro-Ophthalmology
- Vol. 39 (2), 220-231
- https://doi.org/10.1097/wno.0000000000000721
Abstract
Approximately 1 million new cases of herpes zoster (HZ) occur in the United States annually, including 10%–20% with herpes zoster ophthalmicus (HZO). Postherpetic neuralgia, a debilitating pain syndrome occurs in 30% HZ, whereas 50% HZO develop ophthalmic complications. Diplopia from cranial nerve palsy occurs in less than 30% HZO, whereas optic neuropathy is seen in less than 1% HZO. We reviewed recent developments in the diagnosis, treatment, and prevention of HZ as well as neurological and ophthalmological complications of relevance to the neuro-ophthalmologist. We searched the English language literature on Pubmed and Google scholar for articles relevant to the various sections of this review. Antiviral treatment should be initiated within 48–72 hours of onset of HZ and HZO to decrease pain and reduce complications. We recommend neuroimaging in all patients with neuro-ophthalmic manifestations such as diplopia and acute vision loss. Diagnostic confirmation using polymerase chain reaction and serology on paired serum and cerebrospinal fluid samples should be obtained in those with neurological signs and symptoms or abnormal imaging. Patients with neurological and/or retinal varicella zoster virus (VZV) infection should be treated promptly with intravenous acyclovir. Patients with isolated optic neuropathy or cranial nerve palsy can be managed with oral antivirals. The prognosis for visual recovery is good for patients with isolated optic neuropathy and excellent for patients with isolated ocular motor cranial nerve palsy. HZ produces a spectrum of potentially blinding and life-threatening complications that adversely affect quality of life and increase health care costs. Individuals at risk for HZ, such as the elderly and immunocompromised, should be encouraged to receive the highly effective VZV vaccine to prevent HZ and its complications.Keywords
This publication has 107 references indexed in Scilit:
- Valacyclovir in the treatment of acute retinal necrosisBMC Ophthalmology, 2012
- Varicella Zoster Virus Ischemic Optic Neuropathy and Subclinical Temporal Artery InvolvementArchives of Neurology, 2011
- Herpes zoster: A clinical study in 205 patientsIndian Journal of Dermatology, 2011
- Epidemiology and economic burden of herpes zoster and post-herpetic neuralgia in Italy: A retrospective, population-based studyBMC Infectious Diseases, 2010
- Low prevalence of varicella zoster virus and herpes simplex virus type 2 in saliva from human immunodeficiency virus–infected persons in the era of highly active antiretroviral therapyOral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2010
- Complete Unilateral Ophthalmoplegia in Herpes Zoster OphthalmicusJournal of Neuro-Ophthalmology, 2009
- Varicella Zoster Virus Infection: Clinical Features, Molecular Pathogenesis of Disease, and LatencyNeurologic Clinics, 2008
- The varicella zoster virus vasculopathiesNeurology, 2008
- Varicella‐Zoster Virus in the Saliva of Patients with Herpes ZosterThe Journal of Infectious Diseases, 2008
- Post-herpetic neuralgia: Further post-mortem studies of cases with and without painPain, 1991