OBJECTIVES : 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
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.