Optic Neuritis Associated with Herpes Zoster Ophthalmicus: A Systematic Review and Analysis

To systematically review and analyze reported cases of herpes zoster ophthalmicus (HZO)-related optic neuritis (ON) without retinal involvement, a potentially sight-threatening complication of varicella-zoster virus (VZV).
A PRISMA-guided search of online databases from inception to January 31, 2025, identified case reports and series describing HZO-related ON without retinal involvement. Study quality was assessed using Joanna Briggs Institute checklists. Data on demographics, clinical features, diagnostics, treatments, and outcomes were analyzed using SPSS.
Thirty-two studies (1919–2025) comprising 38 patients were included. The mean patient age was 52.6 years (ranging from 6 to 82), with a near-equal gender distribution. Comorbid conditions such as human immunodeficiency virus (HIV) infection, diabetes, and autoimmune disorders were noted in one-third of cases. ON most commonly presented unilaterally and ipsilateral to the dermatome of HZO. The mean interval from HZO onset to ON was approximately 22 days (ranging from 10 days prior to 150 days afterward). Blurred vision and eye pain were the most frequent symptoms. Common signs include visual field defect, congestion, mydriasis, and ophthalmoplegia. Keratitis was the most common observation in slit-lamp examination (62.8% (22 of 35 cases)). Corticosteroid therapy, including high-dose and pulse regimens, was administered in a third-fourth (28 of 38) of patients. In outcome assessment, 52.8% (19 of 36) achieved mild or no impairment, while 36.3% (12 of 36) experienced clinical blindness.
HZO-related ON is an uncommon but significant sight-threatening complication in HZO. Timely diagnosis and appropriate antiviral treatment along with corticosteroid therapy may improve the visual prognosis.

为系统回顾与分析无视网膜受累的带状疱疹性眼病（herpes zoster ophthalmicus, HZO）相关性视神经炎（optic neuritis, ON）病例——该疾病是水痘-带状疱疹病毒（varicella-zoster virus, VZV）感染所致的潜在威胁视力的并发症。
遵循系统综述与元分析优先报告条目（PRISMA）指南，于建库至2025年1月31日期间对在线数据库进行检索，筛选出关于无视网膜受累的HZO相关性ON的病例报告及病例系列研究。采用乔安娜·布里格斯研究所（Joanna Briggs Institute）检查表评估研究质量。使用SPSS对人口统计学特征、临床特征、诊断方法、治疗方案及结局数据进行分析。
共纳入32项研究（时间跨度为1919年至2025年），涉及38例患者。患者平均年龄为52.6岁（年龄范围6~82岁），性别分布近乎均等。三分之一的病例合并人类免疫缺陷病毒（human immunodeficiency virus, HIV）感染、糖尿病及自身免疫性疾病等基础疾病。视神经炎多单侧发病，且与HZO受累皮节同侧。从HZO发病至ON发生的平均间隔约为22天（范围为HZO发病前10天至发病后150天）。视力模糊与眼痛为最常见的首发症状。常见体征包括视野缺损、视盘充血、瞳孔散大及眼肌麻痹。裂隙灯检查中最常见的发现为角膜炎（62.8%，35例中的22例）。38例患者中有28例（约四分之三）接受了糖皮质激素治疗，包括大剂量及冲击方案。在结局评估中，36例患者中的19例（52.8%）视力轻度受损或无损伤，而36例患者中的12例（36.3%）出现临床失明。
HZO相关性ON是HZO中一种少见但具有显著视力威胁的并发症。及时诊断并联合应用恰当的抗病毒治疗与糖皮质激素治疗，可改善患者的视力预后。