Herpes zoster ophthalmicus: the virus strikes back

The objective of this article is (1) to review the range of anterior segment ocular disease caused by varicella-zoster virus (VZV), (2) to discuss the pathophysiology of the mechanisms involved in the ensuing tissue damage, and (3) to bring the reader up to date on the current management and therapy of herpes zoster ophthalmicus (HZO). The design of this article is a review of the literature with special emphasis on the ocular manifestations of HZO. The conclusions reached by this review include that HZO is a common form of the recurrent form of HZ infection caused by VZV. Although HZO is generally benign in most nonimmunocompromised patients, the incidence of ocular complications is high. Immunocompromised hosts manifest HZ (and HZO) in much higher frequencies and develop more severe sequelas, which may lead to loss of vision, dissemination of the virus, or death. An increased incidence of acquired and iatrogenic immunodeficiency states has given rise to a greater occurrence of recurrent VZV infection. Thus, there is a greater need for earlier diagnosis and appropriate management of the protean manifestations of this potentially disastrous disease.