Bilateral Pupillary Involvement as a Clinical Presentation of Herpes Zoster Ophthalmicus

ABSTRACT

Purpose

Herpes zoster ophthalmicus (HZO) is traditionally considered as an unilateral disease. However, subclinical involvements in the contralateral eye structures are evidence, giving rise to a broader understanding of varicella-zoster virus (VZV) infection.

Methods

We enrolled 20 eyes of 10 patients with HZO and 12 eyes of healthy controls to investigate the bilateral features of HZO patients using a hand-held pupillometer and a Cochet-Bonnet esthesiometer.

Results

Maximum pupil size before constriction (INT) and minimum diameter when pupil constricts at peak (END) were significantly smaller in patients affected eyes compared with those in controls (p < .05). Interestingly, INT and END were significantly reduced in contralateral eyes of 20 affected patients and also in comparison to control group (p < .001 and p = .034 respectively).

Conclusion

The contralateral eyes may have subclinical involvement in patients with HZO based on significantly abnormal pupillary light reflex (PLR). Pupillometer provides a primary and convenient method to investigate the anatomy and pathology of the PLR

KEYWORDS:

• Herpes zoster ophthalmicus
• Bilateral pupillary involvement
• pupilometer
• pupillary light reflex
• aricella-zoster virus infection

Author contributions

All authors have participathed sufficiently in this work. Y. Ma contributed to interpretation of data, and drafting the manuscript. Y. Tian and X. Chen enrolled participants, analyzed data and reviewed the manuscript. Y. Feng contributed to conception and design of the study. Y. Feng and R. Agrawal revised the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This study was supported by the grant from the National Natural Science Foundation of China [No.81700799 and 82070926], and Clinical medicine plus X-Yong Scholars project, peking university, 2019, 2020.