{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:57:55Z","timestamp":1785437875959,"version":"3.56.0"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,8]]},"abstract":"\n Purpose:<\/jats:title>\n This study aimed to evaluate the spectrum and incidence of neuro-ophthalmic complications of herpes zoster (HZ) over 14 years at a large tertiary medical center.<\/jats:p>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Retrospective cohort study.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n The study included patients with a confirmed diagnosis of HZ who presented to the neuro-ophthalmology clinic with cranial nerve 3\/4\/6 involvement, optic disc edema, abnormal cerebrospinal fluid, or imaging findings suggestive of meningoencephalitis. Demographic, clinical, imaging, and outcome data were manually collected from electronic medical records. For comparative analysis, data were aggregated into two periods: 2006\u20132012 and 2013\u20132020.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Seventeen patients with neuro-ophthalmic complications were identified. The mean age at presentation was 67 years, and 76% were male. Autoimmune disease was present in 35% of patients, malignant disease in 29%, and 24% were receiving immunosuppressive therapy at HZ onset. Only one patient had documented prior Varicella zoster vaccination. Neuro-ophthalmic manifestations included visual field defect (53%), diplopia (53%), ptosis (47%), and post-herpetic neuralgia (41%). At the end of follow-up, 18% achieved complete recovery, 65% partial improvement, and 12% showed no improvement. The vast majority of patients (82%) presented in 2013\u20132020, with the incidence increasing from 0.1% of new clinic patients in 2006\u20132012 to 0.3% in 2013\u20132020 (\n P<\/jats:italic>\n < 0.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Neuro-ophthalmic manifestations of HZ appear to be increasing, predominantly affect older males, and frequently result in incomplete recovery. Limited neuroimaging findings highlight the primacy of clinical assessment. Larger prospective studies are needed to clarify risk factors and improve management.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ijo.ijo_3219_25","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:00:27Z","timestamp":1785434427000},"page":"1232-1236","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Increased neuro-ophthalmic manifestations of herpes zoster infection incidence: A 14-year cohort study from a tertiary medical center"],"prefix":"10.4103","volume":"74","author":[{"given":"Ella","family":"Nissan","sequence":"first","affiliation":[{"name":"Neuro-Ophthalmology Unit, Goldschleger Eye Institute, Chaim Sheba Medical Center, Ramat Gan, Israel"},{"name":"Ophthalmology Department, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eden","family":"Abergel","sequence":"additional","affiliation":[{"name":"Neuro-Ophthalmology Unit, Goldschleger Eye Institute, Chaim Sheba Medical Center, Ramat Gan, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris Ben Bassat","family":"Mizrachi","sequence":"additional","affiliation":[{"name":"Neuro-Ophthalmology Unit, Goldschleger Eye Institute, Chaim Sheba Medical Center, Ramat Gan, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Huna-Baron","sequence":"additional","affiliation":[{"name":"Neuro-Ophthalmology Unit, Goldschleger Eye Institute, Chaim Sheba Medical Center, Ramat Gan, Israel"},{"name":"Ophthalmology Department, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"issue":"2 Suppl","key":"R1-20260730","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/j.ophtha.2007.10.009","article-title":"Herpes zoster ophthalmicus natural history, risk factors, clinical presentation, and morbidity","volume":"115","author":"Liesegang","year":"2008","journal-title":"Ophthalmology"},{"key":"R2-20260730","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1007\/s40121-024-00990-7","article-title":"Herpes zoster ophthalmicus: Presentation, complications, treatment, and prevention","volume":"13","author":"Litt","year":"2024","journal-title":"Infect Dis Ther"},{"key":"R3-20260730","doi-asserted-by":"crossref","first-page":"2327","DOI":"10.1038\/s41433-024-03030-3","article-title":"Herpes zoster in neuro-ophthalmology: A practical approach","volume":"38","author":"Tao","year":"2024","journal-title":"Eye (Lond)"},{"key":"R4-20260730","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/WNO.0000000000000721","article-title":"Neurological and ophthalmological manifestations of varicella zoster virus","volume":"39","author":"Kedar","year":"2019","journal-title":"J Neuroophthalmol"},{"key":"R5-20260730","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1159\/000535947","article-title":"Case report and literature review: Isolated trochlear nerve palsy due to herpes zoster infection","volume":"15","author":"Srimanan","year":"2024","journal-title":"Case Rep Ophthalmol"},{"key":"R6-20260730","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1097\/WNO.0000000000000607","article-title":"Herpes zoster optic neuropathy","volume":"38","author":"Kaufman","year":"2018","journal-title":"J Neuroophthalmol"},{"key":"R7-20260730","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1080\/21645515.2020.1847582","article-title":"A systematic literature review of herpes zoster incidence worldwide","volume":"17","author":"van Oorschot","year":"2021","journal-title":"Hum Vaccin Immunother"},{"key":"R8-20260730","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1093\/cid\/ciw296","article-title":"Increasing incidence of herpes zoster over a 60-year period from a population-based Study","volume":"63","author":"Kawai","year":"2016","journal-title":"Clin Infect Dis"},{"key":"R9-20260730","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1136\/bjophthalmol-2015-307157","article-title":"Herpes zoster ophthalmicus: Declining age at presentation","volume":"100","author":"Davies","year":"2016","journal-title":"Br J Ophthalmol"},{"key":"R10-20260730","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.ophtha.2019.10.001","article-title":"Incidence rate of herpes zoster ophthalmicus: A retrospective cohort study from 1994 through 2018","volume":"127","author":"Kong","year":"2020","journal-title":"Ophthalmology"},{"key":"R11-20260730","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1111\/bjd.19832","article-title":"Perceived psychological stress and risk of herpes zoster: A nationwide population-based cohort study","volume":"185","author":"Schmidt","year":"2021","journal-title":"Br J Dermatol"},{"key":"R12-20260730","doi-asserted-by":"crossref","first-page":"e29629","DOI":"10.1002\/jmv.29629","article-title":"A systematic review and meta-analysis of herpes zoster occurrence\/recurrence after COVID-19 infection and vaccination","volume":"96","author":"Wang","year":"2024","journal-title":"J Med Virol"},{"key":"R13-20260730","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1056\/NEJMcp1302674","article-title":"Herpes Zoster","volume":"369","author":"Cohen","year":"2013","journal-title":"N Engl J Med"},{"key":"R14-20260730","doi-asserted-by":"crossref","first-page":"120262","DOI":"10.1016\/j.jns.2022.120262","article-title":"Clinical and neuroradiologic characteristics in varicella zoster virus reactivation with central nervous system involvement","volume":"437","author":"Maher","year":"2022","journal-title":"J Neurol Sci"},{"key":"R15-20260730","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/s13365-016-0422-y","article-title":"Central nervous system infections caused by varicella-zoster virus","volume":"22","author":"Chamizo","year":"2016","journal-title":"J Neurovirol"},{"key":"R16-20260730","doi-asserted-by":"crossref","first-page":"2476","DOI":"10.3201\/eid3012.240538","article-title":"Increase in adult patients with varicella zoster virus-related central nervous system infections, Japan","volume":"30","author":"Yoshikane","year":"2024","journal-title":"Emerg Infect Dis"},{"issue":"Pt 2","key":"R17-20260730","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1038\/eye.2000.68","article-title":"Herpes zoster ophthalmicus presenting as contralateral disc swelling","volume":"14","author":"Mearza","year":"2000","journal-title":"Eye (Lond)"},{"key":"R18-20260730","first-page":"61","article-title":"Bilateral retrobulbar neuritis following unilateral herpes zoster ophthalmicus","volume":"208","author":"G\u00fcnd\u00fcz","year":"1994","journal-title":"Ophthalmologica"},{"key":"R19-20260730","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1001\/archopht.1978.03910060067013","article-title":"Isolated trochlear nerve palsies in herpes zoster ophthalmicus","volume":"96","author":"Grimson","year":"1978","journal-title":"Arch Ophthalmol"},{"key":"R20-20260730","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1097\/WNO.0000000000001901","article-title":"Antivirals vs antivirals and steroids for treatment of herpes zoster-related ophthalmoplegia: A case series and systematic review","volume":"44","author":"Sverdlichenko","year":"2024","journal-title":"J Neuroophthalmol"},{"key":"R21-20260730","doi-asserted-by":"crossref","first-page":"ofw205","DOI":"10.1093\/ofid\/ofw205","article-title":"Risk of herpes zoster in individuals on biologics, disease-modifying antirheumatic drugs, and\/or corticosteroids for autoimmune diseases: A systematic review and meta-analysis","volume":"3","author":"Marra","year":"2016","journal-title":"Open Forum Infect Dis"},{"key":"R22-20260730","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1086\/598331","article-title":"Herpes zoster risk factors in a national cohort of veterans with rheumatoid arthritis","volume":"48","author":"McDonald","year":"2009","journal-title":"Clin Infect Dis"}],"container-title":["Indian Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_3219_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:00:46Z","timestamp":1785434446000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_3219_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":22,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ijo.ijo_3219_25","relation":{},"ISSN":["0301-4738","1998-3689"],"issn-type":[{"value":"0301-4738","type":"print"},{"value":"1998-3689","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,31]]},"assertion":[{"value":"2025-12-14","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-15","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}