Herpes Zoster Ophthalmicus

  • Emma Davies
  • James ChodoshEmail author
  • Deborah Pavan-Langston


Herpes zoster ophthalmicus (HZO) is the reactivation of latent varicella zoster virus (VZV) in the first and/or second division of the trigeminal nerve. The dermatome served by the trigeminal nerve is a common site for reactivation, second only to the thoracic dermatomes, with approximately 250,000 cases of HZO annually in the United States [1, 2]. Several studies have demonstrated a steadily increased incidence of HZO over the past two decades. In one study of Medicare enrollees, the incidence of HZO was found to increase from 1.7 per 1000 in 1993 to 4.4 per 1000 in 2006 [3]. There are several possible explanations for this rise in incidence including the aging population, increased number of immunocompromised patients, and introduction of the varicella vaccination. It has been hypothesized that VZV reactivates in the setting of waning T cell immunity, as occurs with aging (greatest decline in immune system response occurs in the fifth to seventh decade of life) and immunocompromised (from HIV, blood dyscrasias, and the use of immunosuppressant medications) [4]. While the introduction of a mandatory two-dose varicella vaccination program in the United States in 2006 has been suggested to reduce repeat exposure to VZV and therefore limit natural immune boosting against VZV in adults [5–8], this is by no means an accepted theory. Additional details on this subject are presented in Chap.  2. Herpes zoster reactivation has never reliably been shown to have a racial or gender predilection.


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Emma Davies
    • 1
  • James Chodosh
    • 1
    Email author
  • Deborah Pavan-Langston
    • 1
  1. 1.Massachusetts Eye and Ear Infirmary, Cornea and External Diseases, Harvard Medical School, Department of OphthalmologyBostonUSA

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