Herpes Zoster Ophthalmicus in Older Adults Poses Serious Risk to Vision, Indonesian Case Report Shows
A clinical case report published in 2026 highlights how Herpes Zoster Ophthalmicus (HZO)—a reactivation of the chickenpox virus affecting the eye—can quickly threaten vision in older adults if not treated early. The report was written by Arsyiva Putri Azhari and Mila Karmila from Malikussaleh University, Indonesia, and appeared in the International Journal of Integrative Sciences (IJIS). Based on the documented case of a 60-year-old woman, the article underscores the urgent need for early recognition and prompt antiviral treatment to prevent long-term eye damage and potential blindness.
Herpes Zoster Ophthalmicus occurs when the varicella-zoster virus, which remains dormant in the body after childhood chickenpox, becomes active again and attacks nerves connected to the eye. Although shingles is widely known as a painful skin condition, its ophthalmic form is far more dangerous. When the virus reaches ocular structures, it can cause inflammation of the cornea, inner eye tissues, and optic nerve, leading to lasting visual impairment.
Why Herpes Zoster Ophthalmicus Matters
Globally, herpes zoster affects millions of older adults each year. Medical literature shows that 10–20 percent of all shingles cases involve the eye, and more than half of those patients develop some form of ocular complication. With aging populations in many countries, including Indonesia, the burden of herpes zoster–related eye disease is expected to rise.
The case described by Arsyiva Putri Azhari and Mila Karmila reflects this growing concern. The patient, a 60-year-old housewife, arrived at an ophthalmology clinic with persistent pain around her right eye, a blistering facial rash, eye redness, and declining vision. Her symptoms began two weeks earlier with a burning sensation on one side of the face, followed by clusters of fluid-filled blisters that did not cross the midline—an important clinical clue for shingles.
By the time she received specialist care, the virus had already affected key structures of the eye.
How the Case Was Documented
The authors used a clinical case report design, a common approach in medical research to describe rare or high-risk conditions in detail. Data were collected through patient interviews, physical examination, ophthalmologic assessment, and routine laboratory tests.
Eye examinations revealed several classic signs of Herpes Zoster Ophthalmicus, including:
1. Conjunctival hyperemia, or redness of the eye surface
2. Pseudodendritic keratitis, a distinctive pattern of corneal inflammation linked to shingles
3. Corneal infiltrates, indicating deeper tissue involvement
4. Suspected anterior uveitis, an inflammatory condition inside the eye
5. A positive Hutchinson’s sign, marked by blisters on the nose, which strongly predicts eye involvement
Laboratory blood tests were largely normal, reinforcing the fact that HZO diagnosis often depends on clinical observation rather than lab abnormalities alone.
Key Findings from the Case
The report clearly documents how delayed treatment increases the risk of severe eye complications. In this patient:
1. Eye involvement developed even though the initial rash appeared outside the classic ophthalmic nerve area.
2. Visual acuity in the affected eye dropped significantly compared to the unaffected eye.
3. The presence of Hutchinson’s sign correlated with keratitis and suspected uveitis.
4. The patient had not received antiviral therapy within the critical first 72 hours after rash onset.
Despite the late presentation, doctors initiated systemic antiviral therapy with acyclovir, along with supportive eye treatments such as antibiotic ointment and lubricating eye drops. Proper eye hygiene and skin lesion care were also emphasized.
According to the authors, timely treatment remains beneficial even when patients present late, as it can still reduce inflammation and prevent further deterioration.
Clinical and Public Health Implications
This case has direct implications for patients, clinicians, and health systems. For the public, it reinforces the message that facial pain and blistering near the eye require immediate medical attention, especially in older adults. For primary care providers, it highlights the importance of rapid referral to ophthalmology when shingles affects the face.
From a policy perspective, the findings support broader discussions around herpes zoster vaccination for older populations. Vaccination has been shown internationally to reduce both shingles incidence and severe complications such as Herpes Zoster Ophthalmicus.
“Early recognition and appropriate management are essential to prevent vision-threatening complications,” Arsyiva Putri Azhari of Malikussaleh University noted in the discussion, emphasizing that delays can result in chronic eye disease, scarring, and permanent visual loss.
Why Timing Is Critical
Medical evidence consistently shows that antiviral treatment is most effective when started within 72 hours of rash appearance. Early therapy reduces viral replication, limits nerve damage, and lowers the risk of post-herpetic neuralgia and ocular complications. In contrast, delayed treatment—as seen in this case—raises the likelihood of prolonged pain and lasting vision problems.
The authors stress that Herpes Zoster Ophthalmicus should be treated as a medical urgency, not a routine skin condition.
Author Profiles
Arsyiva Putri Azhari Malikussaleh University
Mila Karmila, Malikussaleh University,
Source
Journal Article Title: Herpes Zoster Ophthalmicus
Authors: Arsyiva Putri Azhari, Mila Karmila
Journal: International Journal of Integrative Sciences (IJIS)
Year: 2026
DOI: https://doi.org/10.55927/ijis.v5i1.803
This article is published by Formosa News as a science news feature based on peer-reviewed medical research, with the goal of improving public understanding of eye health risks associated with herpes zoster.
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