• Written By:
    Cornea/External Disease, Uveitis

    This study gauged the risk of anterior segment complications after vaccination with the live herpes zoster virus.

    Study design

    Researchers retrospectively reviewed the records of 217,845 patients with naïve or recurrent herpes zoster ophthalmicus (HZO) from a health claims database during a 10-year period. The patients were separated into 4 cohorts. Cohorts 1 and 2 were HZO-naïve: Cohort 1 received the zoster vaccine while cohort 2 developed nonophthalmic zoster. Cohorts 3 and 4 each had prior documented episodes of HZO. Patients in cohort 3 received the zoster vaccine while patients in cohort 4 subsequently developed nonophthalmic zoster. Each cohort was followed for subsequent zoster-related ocular events including keratitis, uveitis, corneal opacity or blepharoconjunctivitis.  


    The overall rate of anterior segment complications was similar in HZO-naive cohorts 1 and 2, with an adjusted HR of 0.89. The same was true for recurrent HZO cohorts 3 and 4 with an adjusted HR of 0.7.

    The mean time to an HZO-related anterior segment event was shorter in the vaccinated cohorts than in those who developed non-ophthalmic zoster, suggesting that a systemic zoster event may strengthen the immune system (and delay HZO recurrence) for a longer period of time than the live vaccine.


    This study was limited by the type of information available in the health claims database. Individual charts could not be reviewed for accuracy. Posterior segment HZO-related complications were not included in the analysis. This study was completed prior to widespread use of the new non-live recombinant subunit herpes zoster vaccine.

    A major strength of this study, however, is the large sample size. While diagnostic coding from nonophthalmologists was included to capture as many events as possible, this could potentially lower the diagnostic specificity.

    Clinical significance

    This retrospective cohort study did not find an increased risk of anterior segment complications associated with the live herpes zoster vaccine. There was no link identified between receiving the vaccine after an episode of HZO and re-activating anterior segment disease.