Herpes zoster ophthalmicus in Olmsted County, Minnesota: Have systemic antivirals made a difference?

Objective: To determine the frequency of complications and adverse outcomes due to herpes zoster ophthalmicus before and after the introduction of oral antiviral medications in a community-based setting. Methods: We identified all Olmsted County, Minnesota, residents diagnosed with acute herpes zoster ophthalmicus from 1976 through 1998. The frequencies of complications within 6 months of disease onset were compared between untreated patients vs those treated with antivirals. Main Outcome Measures: Defined complications were ocular sequelae due to herpes zoster ophthalmicus. Adverse outcomes included visual acuity of 20/200 or worse, trichiasis, or eyelid malposition requiring surgical treatment. Results: A total of 202 patients had been treated with antivirals, and 121 had not. Neurotrophic keratitis was the only complication that was less likely in the treated group (3.3% vs 0%; P=.02). The probability of an adverse outcome at 5 and 10 years was 8.9% among untreated patients and 2.1% among treated patients (P=.009). Among patients who had been treated, the mean time from symptom onset to initiation of therapy was 4.8 days in those who developed stromal keratitis, corneal edema, scleritis, uveitis, or glaucoma compared with 3.8 days in those who did not (P=.006). Conclusions: Neurotrophic keratitis was less frequent among patients who received antiviral therapy. However, among treated patients, development of a serious inflammatory complication was associated with a delay in therapy. Most important, adverse outcomes were less probable in the treated group. These data may support the early and routine use of systemic antiviral therapy for acute herpes zoster ophthalmicus.