Advanced Age and Multiple Comorbidities May Be Factors in Poor Prognosis for HZO

Although extraocular muscle paralysis is commonly associated with herpes zoster ophthalmicus (HZO), extraocular movements should be carefully examined, because eye movement may not improve, even with treatment, for individuals who are older and have multiple comorbid diseases, study results show.

Investigators found that treatment response may be poor in elderly individuals with comorbidities, even though treatment generally has a good prognosis.

Advanced age and comorbidities could potentially be factors that negatively affect treatment of HZO.

The study included cases from 2 different individuals: a 67-year-old woman who also has diabetes, hypertension, and coronary heart disease with fourth and sixth cranial nerve complete palsy, and a 76-year-old man with hypertension, diabetes, and heart failure with only sixth cranial nerve complete palsy.

The woman visited the center with diplopia and pain in the right half of her face for 5 days. She also experienced blisters on her forehead and scalp. A neurological examination identified the right trochlear and abducens complete paralysis. However, there was no vision loss detected.

She was diagnosed with HZO and administered methylprednisolone 1mg/kg daily, orally, and acyclovir 2400 mg daily, intravenously, for a 14-day period.

Follow-ups were performed for 6 months, but no improvement was observed in her extraocular muscle complete paralysis and diplopia.

The second patient visited the center because of persistent blistering, redness, and swelling around the right eye for 4 days. Neurological examinations showed a limitation in movement to the right eye, but there was no vision loss detected.

He was diagnosed with HZO, with abducens complete paralysis and was administered acyclovir 3000 mg daily for 3 days, intravenously, but the treatment was stopped, because of the development of nephropathy secondary related to the medication.

When renal functions normalized, brivudine 125 mg daily was administered.

Follow-ups were performed for 6 months, but there was no improvement in his extraocular muscle complete paralysis and diplopia.

HZO develops when a varicella-zoster virus infection is reactivated, generally in individuals who are immunocompromised, and leads to chronic ocular complications.

The third cranial nerve is typically seen among individuals experiencing cranial neve palsies, but the fourth and sixth nerves may also be involved.

The findings were published in Cureus.

Reference

Varoğlu AO. Avarisli, A. Advanced age and multiple comorbidities as important factors in predicting poor prognosis in herpes zoster ophthalmicus. Cureus.2021;13(9):e18412. doi:10.7759/cureus.18412