HERPES-ZOSTER OPHTHALMICUS - THE VIRUS STRIKES BACK

The objective of this article is (1) to review the range of anterior s egment ocular disease caused by varicella-zoster virus (VZV), (2) to d iscuss the pathophysiology of the mechanisms involved in the ensuing t issue damage, and (3) to bring the reader up to date on the current ma nagement and therapy of herpes zoster ophthalmicus (HZO). The design o f this article is a review of the literature with special emphasis on the ocular manifestations of HZO. The conclusions reached by this revi ew include that HZO is a common form of the recurrent form of HZ infec tion caused by VZV. Although HZO is generally benign in most nonimmuno compromised patients, the incidence of ocular complications is high. I mmunocompromised hosts manifest HZ (and HZO) in much higher frequencie s and develop more sere sequelas, which may lead to loss of vision, di ssemination of the virus, or death. An increased incidence of acquired and iatrogenic immuondeficiency states has given rise to a greater oc currence of recurrent VZV infection. Thus, there is a greater need for earlier diagnosis and appropriate management of the protean manifesta tions of this potentially disastrous disease.