HZO-associated ophthalmoplegia has good long-term prognosis

This retrospective chart review found that ophthalmoplegia secondary to herpes zoster ophthalmicus (HZO) has a good long-term prognosis for recovery.

The study included 18 patients with ocular motor cranial nerve palsy occurring at the time of HZO who were seen by one neuro-ophthalmologist from 1994 to 2012.

The mean interval between HZO onset and ophthalmoplegia was 8.6 days and ranged from 1 to 15 days. All patients were already on oral antivirals (acyclovir or valacyclovir) at the time of referral. Seven patients were also treated with a short course of oral prednisone.

Over a mean follow-up of 10 weeks, nine patients experienced complete recovery and eight had partial recovery but no diplopia in primary gaze. One patient with complete ophthalmoplegia had mild improvement but persistent diplopia in primary gaze for six months, after which he was lost to follow-up.

The authors say it is possible that the follow-up duration was too short and that patients with incomplete recovery (diplopia in eccentric gaze) could have recovered completely over a longer period of time. But nevertheless, they say their report shows that patients with ophthalmoplegia after HZO have a good prognosis with almost all recovering from diplopia at least in primary gaze.