Increased Risk of Corneal Ulcers in Herpes Zoster Ophthalmicus Patients, suggests study
According to a new study published in Frontiers in Medicine patients with herpes zoster ophthalmicus (HZO) are at a much greater risk of corneal ulcers. HZO is a severe disease resulting from reactivation of the varicella-zoster virus, which infects the ophthalmic branch of the trigeminal nerve. This reactivation may result in ocular surface disorders such as exposure keratopathy and superficial punctate keratitis, with a very high risk of infectious corneal ulcers. The study was conducted by Shih-Feng Weng and colleagues.
This was a nationwide, population-based, retrospective, matched-cohort study performed from the data in the Taiwan National Health Insurance Research Database. There were 44,317 newly diagnosed HZO patients and a control group of 132,951 patients without HZO. Patient information was obtained from January 1, 2004, to December 31, 2011, and both cohorts were followed until December 2013. Adjusted hazard ratio (HR) for the development of corneal ulcers was determined by Cox proportional hazards regression analysis, and cumulative incidence was compared using Kaplan–Meier analysis.
Key Findings
• Out of the 44,317 HZO patients, 1,374 had developed corneal ulcers versus 938 in the control population.
• The rate of corneal ulcers in the HZO group was 4.59 times greater than in the control group (95% CI = 4.23–4.99; p < 0.0001).
• After controlling for confounders like diabetes, trait of atopy, chronic renal disease, eye allergies, HIV, and contact lens wearers, patients with HZO had 4.53 times greater chances of developing corneal ulcers (adjusted HR = 4.53; 95% CI = 4.17–4.93; p < 0.05).
The research proved that HZO considerably escalates the risk of corneal ulceration. The increased rate of corneal ulcers in HZO patients can be attributed to exposure keratopathy, which compromises the ocular surface barrier, rendering the eye vulnerable to infection. The correlation between HZO and risk of corneal ulcer remained significant even when controlling for multiple confounders, highlighting the importance of proper monitoring of the patients.
This study authors reaffirm that patients with HZO are significantly at risk of the occurrence of corneal ulcers. Health care providers need to counsel patients with HZO regarding this risk and promote early identification and treatment of any ocular complications.
Reference:
Weng, S.-F., Chang, Y.-S., Wang, J.-J., Jan, H.-Y., Chen, J.-Y., Tseng, S.-H., & Jan, R.-L. (2025). Association between herpes zoster ophthalmicus and the risk of corneal ulcer. Frontiers in Medicine, 12.https://doi.org/10.3389/fmed.2025.1529908
