Bilateral nerve damage found in patients with unilateral herpes zoster ophthalmicus

This prospective study found significant bilateral corneal nerve damage in patients with unilateral herpes zoster ophthalmicus (HZO), a finding that calls into question not only the nature of HZO but also of contralateral eye reactions.

The authors used in vivo confocal microscopy to prospectively analyze bilateral corneal nerve damage and sensation in 27 patients with HZO and normal controls.

Patients with unilateral HZO demonstrated profound and significant corneal nerve damage compared with controls, not only in the clinically affected eyes but also in their unaffected contralateral eyes. Moreover, there was a significant correlation of corneal sensation with corneal nerve damage.

The authors write that the contralateral loss of corneal nerves was completely unexpected. This finding suggests that the use of contralateral eyes as controls or as so-called independent eyes to measure outcome parameters should be rethought because it may lead to erroneous results. In the case of the cornea, sensation measurements with or for corneal innervation via in vivo confocal microscopy are advisable. Further studies of the bilateral involvement of shingles will help to further the understanding of the pathophysiologic features of this disease.