Uveitis associated with zoster sine herpete. Diagnosis and clinical findings

Objective: Zoster sine herpete (ZSH) causes solely neurologic symptoms without the eruption that is evident in herpes zoster ophthalmicus. It is occasionally complicated by acute granulomatous uveitis. We examined patients suspected of ZSH for detection of the varicella-zoster virus (VZV) genome, and discussed its clinical appearance.

Methods: Nine patients were presumed to have ZSH. All manifested acute granulomatous iridocyclitis and high intraocular pressure without eruption. A polymerase chain reaction (PCR) analysis of the aqueous humor was performed.

Results: Five patients were positive for VZV DNA. They showed mutton-fat keratic precipitates and high intraocular pressure in the early stage. Pigmentation in the anterior chamber angle, pigmented keratic precipitates, and finally sectoral iris atrophy were observed in the recovery stage. These clinical findings were common to ZSH.

Conclusions: The ocular lesions in ZSH were shown to have distinctive characteristics, and PCR is useful to determine etiological agents in the early stage of disease.