• Written By: Damien M Luviano MD and Kaelyn Adams BS
    Comprehensive Ophthalmology, Cornea/External Disease

    Review of: Incident rates of Herpes Zoster Ophthalmicus. A Retrospective Cohort Study from 1994 through 2018

    Kong C, Thompson R, Porco T, et al. Ophthalmology, March 2020

    Investigators analyzed changes in the incidence rate of herpes zoster ophthalmicus (HZO) from 1994 through 2018.

    Study design

    This retrospective, observational cohort study from 1994 to 2018 tracked the incidence rate of herpes zoster ophthalmicus (HZO), which is a form of HZ that occurs when varicella zoster virus reactivates along the ophthalmic branch of the trigeminal nerve. Researchers included 633,474 cases of HZ in the United States in the analysis; 49,745 (7.9%) had HZO.


    The incidence of HZO increased from 1994 through 2018 by an estimated 1.1 cases per 100,000 person-years annually. The incidence of HZO increased 3.6% per year from 1994 to 2018. Since 2008, HZO incidence declined in individuals younger than 21 years and older than 60 years while increasing at a lower rate in middle-aged adults. Men had a lower incidence rate of HZO compared with women [incidence rate ratio (IRR) of 0.74]. Compared with white patients, the IRRs were 0.70 for Asians, 0.75 for black patients and 0.64 for Hispanics.


    The study was not able to compare HZO incidence between periods before and after the introduction of the varicella vaccine in 1996, which would have provided additional clarification on changing HZO patterns as a result of vaccination.

    Clinical significance

    Due to the continued increase in HZO incidence among individuals between 31 to 60 years of age, it is crucial for clinicians to support efforts to vaccinate adults older than 50 years as per guidelines and to support more research on earlier vaccination to decrease HZ and HZO in this group.