title: Ocular involvement and visual outcome of herpes zoster ophthalmicus: review of 45 patients from Tunisia, North Africa.
abstract: BACKGROUND
  Ocular complications of herpes zoster ophthalmicus (HZO) may lead to substantial visual impairment. The purpose of this study was to characterize and analyze ocular involvement and visual outcome of HZO in patients from Tunisia, North Africa. This study is a retrospective chart review of 51 eyes of 45 patients with HZO.
  
  
  RESULTS
  Mean age was 44.5 years. Thirty patients (66.7%) were aged over 50 years. Twenty-four patients (53.3%) were male and 21 patients were female (46.7%). There was no statistically significant difference in gender distribution. Initial mean best corrected visual acuity (BCVA) was 20/50. Ocular manifestations included adnexal involvement (58.8%), keratitis (31.4%), keratouveitis (31.4%), isolated anterior uveitis (AU) (29.4%), intraocular pressure elevation (23.5%), oculomotor nerve palsy (5.8%), and optic neuritis (1.9%). Isolated AU (p < 0.001), isolated keratitis (p = 0.001), and intraocular pressure elevation (p = 0.013) were more likely to be concomitant to HZO active skin disease, while keratouveitis occurred more likely more than 1 month after HZO eruption (p < 0.001). AU and keratouveitis were more likely to be associated with age ≥ 50 years (p = 0.001 and p = 0.02, respectively). Ocular complications included neurotrophic keratopathy (1.9%), corneal opacity (5.9%), secondary glaucoma (7.8%), optic atrophy (1.9%), and postherpetic neuralgia (13.3%). Mean follow-up was 12 months. Mean final BCVA was 20/32; it was ≥ 20/40 in 78.4% of the eyes.
  
  
  CONCLUSIONS
  Our study provided epidemiologic and clinical data of HZO in a Tunisian population. AU and keratitis were the most common ocular complications. Neurotrophic keratopathy was scarce. The overall visual outcome is good, with about three quarters of the treated patients maintaining VA of 20/40 or better.
authors.affiliation: Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, 5019, Tunisia.
authors.forename: Rim
authors.initials: R
authors.lastname: Kahloun
authors.affiliation: Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, 5019, Tunisia.
authors.forename: Sonia
authors.initials: S
authors.lastname: Attia
authors.affiliation: Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, 5019, Tunisia.
authors.forename: Bechir
authors.initials: B
authors.lastname: Jelliti
authors.affiliation: Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, 5019, Tunisia.
authors.forename: Ahmed Zakaria
authors.initials: AZ
authors.lastname: Attia
authors.affiliation: Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, 5019, Tunisia.
authors.forename: Sana
authors.initials: S
authors.lastname: Khochtali
authors.affiliation: Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, 5019, Tunisia.
authors.forename: Salim Ben
authors.initials: SB
authors.lastname: Yahia
authors.affiliation: Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, 5019, Tunisia.
authors.forename: Sonia
authors.initials: S
authors.lastname: Zaouali
authors.affiliation: Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, 5019, Tunisia.
authors.forename: Moncef
authors.initials: M
authors.lastname: Khairallah
keywords: Epidemiology; Herpes zoster ophthalmicus; Keratitis; Keratouveitis; Uveitis; Varicella zoster virus; Visual outcome