Corneal complications of herpes zoster ophthalmicus. Prevention and treatment

Corneal complications of herpes zoster ophthalmicus include pseudodendritic keratitis, late mucous adherent keratopathy, varied forms of stromal keratitis, and exposure/neurotrophic keratopathy. Prophylactic therapy of acute herpes zoster ophthalmicus with oral acyclovir is of proven benefit in reducing the incidence of early pseudodendritic keratopathy and stromal keratitis but has no evident effect on exposure/neurotrophic keratopathy. Although early pseudodendritic keratitis is due to virus infection of epithelial cells, it is self-limited and does not require topical antiviral therapy. Stromal keratitis and associated epithelial mucous adherent keratopathy are responsive to topical corticosteroids but chronic therapy is often required and may prolong the duration of keratitis and result in cataract or secondary glaucoma. Exposure and neurotrophic keratopathy may respond to topical lubricants and correction of lid abnormalities but severely affected corneas may require tarsorrhaphy or conjunctival flap to maintain corneal integrity.