Herpes zoster (HZ) is caused by reactivation of latent varicella zoster virus (VZV) in people who have had
chicken pox, usually resulting in a painful, unilateral, dermatomal, vesicular
rash.
Herpes zoster ophthalmicus occurs when the first division of cranial nerve V is involved. HZ is common, with approximately 1 million new cases per year in the United States, and occurs in 1 in 3 persons. Although the rate of HZ increases with age, over half of all cases occur under the age of 60 years. Complications of
herpes zoster ophthalmicus include
eye disease,
postherpetic neuralgia (PHN), and
strokes. VZV has also been found in
temporal arteritis biopsies. There is growing evidence that HZ is followed by chronic active VZV
infection contributing to these complications. In view of this, and the efficacy of suppressive
antiviral treatment in reducing recurrent
herpes simplex keratitis, a randomized controlled trial of suppressive
valacyclovir to reduce new or worsening anterior segment disease and/or PHN is needed. The
zoster vaccine (ZV) is safe and effective in reducing the burden of illness, severity of PHN, and incidence of HZ. It is Centers for Disease Control and Prevention recommended for persons aged 60 years and above without impaired cellular immunity, and Food and Drug Administration approved for those aged 50 and older. It is most effective in preventing HZ in recipients in their 50s. Because of underusage of the ZV, it has not impacted the epidemiology of the disease. Barriers to its use include cost, variable reimbursement, frozen storage, and lack of a strong recommendation by doctors.