Feature Article

Unboxing herpes zoster ophthalmicus and the recombinant shingles vaccine

Feature Article

Unboxing herpes zoster ophthalmicus and the recombinant shingles vaccine

TIA McLAREN, ERICA DARIAN-SMITH, MINAS T. CORONEO

Figures

© inside creative house/ istockphoto.com model used for illustrative purposes only
© inside creative house/ istockphoto.com model used for illustrative purposes only

Abstract

Reactivation of the varicella zoster virus as herpes zoster (shingles) typically affects the peripheral nerves, resulting in a painful rash, most often on the torso. However, it can also manifest ophthalmologically, affecting the ophthalmic division of the trigeminal nerve. This manifestation is associated with a particularly high level of morbidity and may result in blindness. A new recombinant shingles herpes zoster vaccine protects patients against this virus and post-infection sequelae, improving medical and psychosocial outcomes.

Key Points

  • Varicella zoster virus reactivation in adulthood manifests as herpes zoster and is characterised by a painful vesicular rash in a unilateral dermatomal pattern in the distribution of a cranial nerve or dorsal root ganglion.
  • Postherpetic neuralgia (PHN) is the most common long-term sequela of herpes zoster.
  • Herpes zoster can involve the ophthalmic division of the trigeminal nerve, referred to as herpes zoster ophthalmicus (HZO), and can result in chronic pain, reduced quality of life and permanent vision loss.
  • Early treatment of HZO rash with antiviral therapy reduces the incidence of ocular complications but is ineffective in reducing PHN.
  • A new recombinant subunit vaccine, Shingrix, is now available in Australia for people aged 50 years and over and is highly efficacious in preventing herpes zoster and PHN.
  • Referral to an ophthalmologist is crucial if patients present with signs of HZO, including the presence of vesicles on the tip of the nose or signs of anterior uveitis.