ID-5184 Wonca Abstracts supplement L-Z 13-10-23 - Flipbook - Page 40
WONCA 2023 Supplement 2: WONCA 2023 abstracts (L–Z)
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Burden and complications of herpes zoster ophthalmicus:
Preventable by vaccination
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A/Prof John Litt1, Anthony L Cunningham2, Francisco Arnalich3, Dr Raunak Parikh4
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College of Medicine and Public Health, Flinders University, Adelaide, 2Faculty of Medicine and Health,
University of Sydney, Sydney, 3Cornea Unit, Department of Ophthalmology, Ramón y Cajal University
Hospital, Madrid, 4GSK, Wavre
Herpes zoster ophthalmicus (HZO) involves latent varicella-zoster virus reactivation within the
ophthalmic branch of the trigeminal nerve. Due to the risk of complications, HZO is considered an
emergency requiring ophthalmic consultation. Recognising the clinical signs is key to early treatment.
A non-systematic literature review evaluated HZO burden, complications and patient management.
The PubMed search for ‘(zoster[Title/Abstract]) AND (ophthalm*[Title/Abstract])’ (2015–2023) revealed
429 articles, including 132 of relevance.
Approximately 8–20% of patients with herpes zoster (HZ) develop HZO. Consistent with HZ
epidemiology, adults aged ≥60 years and immunocompromised individuals experience higher HZO
incidence and more severe disease. Up to 25% of patients may develop chronic or recurrent HZO.
Clinical signs include facial herpetic rash, sometimes preceded by neuropathic pain, fever and
headaches. Ocular involvement increases if the rash extends to the tip of the nose (Hutchinson’s sign),
flagging nasociliary branch involvement. Without antiviral therapy, approximately 50% of patients with
HZO develop ocular manifestations, including conjunctivitis, uveitis, episcleritis, keratitis and retinitis.
Ocular symptoms include discomfort, discharge, redness, pain and photophobia. One in 10 patients
develop moderate or severe vision loss, which can be permanent. Other complications include risk of
cardiovascular events and stroke.
Antivirals, topical steroids and pain medication are the mainstay of treatment. Antiviral initiation within
72 h of rash/new ocular involvement reduces chronic ocular complications by 20–30%.
Two HZ vaccines are available: a live-attenuated vaccine and a non-live recombinant, adjuvanted
vaccine. The latter has fewer contraindications but higher reactogenicity. In independent real-world
US studies, vaccine effectiveness in preventing HZO has been reported as 27–63% for live-attenuated
vaccines and 67–89% for non-live recombinant, adjuvanted vaccines. Primary care physicians should
consider vaccination in preventing HZO and its complications.
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