title: Early- and late-stage ocular complications of herpes zoster ophthalmicus in rural South Africa.
abstract: OBJECTIVE
  To describe the spectrum of ocular complications of herpes zoster ophthalmicus (HZO) in rural South Africa.
  
  
  METHODS
  Patients presenting with visual complaints and active or healed HZO at the ophthalmology outpatient department of three hospitals in rural South Africa were included in this study. Demographic and clinical data were collected, and HIV status was determined for all participants.
  
  
  RESULTS
  Forty-eight patients were included, and 81% were HIV infected. Poor vision was reported by 94% of patients, painful eye by 79% and photophobia by 63%. A diverse spectrum of ocular complications was observed with corneal inflammation and opacification in 77% followed by anterior uveitis in 65%. The majority (65%) presented with late-stage ocular complications associated with irreversible loss of vision whereas early-stage complications, such as punctate epithelial keratitis and anterior uveitis, were less common. Blindness of the affected eye was observed in 68% of patients with late-stage complications. There was a considerable delay between onset of symptoms and first presentation to the ophthalmology outpatient department (median time 35 days; range 1-2500 days), and longer delay was associated with late-stage ocular complications (P = 0.02).
  
  
  CONCLUSIONS
  HZO patients present with relatively late-stage ocular complications, and blindness among these patients is common. The delayed presentation to the ophthalmology outpatient department of hospitals in our rural setting is of concern, and efforts to improve ocular outcomes of HZO are urgently needed.
authors.affiliation: Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands.|Rotterdam Eye Hospital, Rotterdam, The Netherlands.|Anova Health Institute, Johannesburg and Tzaneen, South Africa.
authors.forename: Erik
authors.initials: E
authors.lastname: Schaftenaar
authors.affiliation: Department of Ophthalmology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Christina
authors.initials: C
authors.lastname: Meenken
authors.affiliation: Rotterdam Eye Hospital, Rotterdam, The Netherlands.|Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.
authors.forename: G Seerp
authors.initials: GS
authors.lastname: Baarsma
authors.affiliation: Anova Health Institute, Johannesburg and Tzaneen, South Africa.|School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: James A
authors.initials: JA
authors.lastname: McIntyre
authors.affiliation: Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands.|Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine, Hannover, Germany.
authors.forename: Georges M G M
authors.initials: GM
authors.lastname: Verjans
authors.affiliation: Anova Health Institute, Johannesburg and Tzaneen, South Africa.|Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.
authors.forename: Remco P H
authors.initials: RP
authors.lastname: Peters
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001766:Blindness / Q000209:etiology / Q000821:virology; D057210:Delayed Diagnosis / Q000009:adverse effects; D058447:Eye Pain / Q000209:etiology; D005260:Female; D015658:HIV Infections / Q000150:complications; D006563:Herpes Zoster Ophthalmicus / Q000150:complications*; D014645:Herpesvirus 3, Human; D006801:Humans; D008297:Male; D008875:Middle Aged; D020795:Photophobia / Q000209:etiology; D012424:Rural Population; D013019:South Africa; D055815:Young Adult
keywords: Afrique du Sud; Herpes zoster oftalmicus; Sudáfrica rural; VIH; complicaciones oculares; complications oculaires; herpes zoster ophthalmicus; human immunodeficiency virus; ocular complications; rural; rural South Africa; zona ophtalmique