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. 2024 Dec 6;38(1):69-75.
doi: 10.1080/08998280.2024.2426439. eCollection 2025.

Herpes zoster ophthalmicus temporally after COVID-19 vaccination: a systematic review of uncontrolled case reports and case series

Jawad Muayad  1 , Hamza Masood  1 , Zaryab Alam  1 , Asad Loya  2 , Andrew G Lee  1   2   3   4   5   6   7   8
Affiliations

Herpes zoster ophthalmicus temporally after COVID-19 vaccination: a systematic review of uncontrolled case reports and case series

Jawad Muayad et al. Proc (Bayl Univ Med Cent). .

Abstract

Purpose: Herpes zoster ophthalmicus (HZO) following COVID-19 vaccination has been reported previously but the clinical characteristics, onset, treatment, and outcomes of these cases have not been previously systematically reviewed.

Methods: A systematic review, guided by PRISMA guidelines, surveyed PubMed and Embase databases from April 2021 to June 2023 for case reports and series detailing HZO following COVID-19 vaccination. Studies excluded were abstracts, reviews, and clinical trials. A subsequent descriptive analysis was performed, focusing on patient demographics, clinical characteristics, and outcomes.

Results: Sixteen publications involving 27 participants who developed HZO post-COVID-19 vaccination met the inclusion criteria. The onset of HZO averaged 13 days (SD 12) postvaccination, predominantly after the first dose (n = 20/27 HZO cases, 74%). Most patients (70%) had preexisting medical conditions. Antiherpetic antiviral therapy was utilized in all cases, with the majority achieving resolution of cutaneous and ocular symptoms. Long-term sequelae included postherpetic neuralgia in 7.4% of patients.

Conclusion: Cases of HZO following COVID-19 vaccination generally mirror the clinical trajectory of HZO in general. This review focused on case reports describing HZO occurring in an interval postvaccination; neither association nor causation can be addressed methodologically.

Keywords: COVID-19 vaccination; herpes zoster ophthalmicus; systematic review; varicella-zoster virus.

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Conflict of interest statement

Andrew G. Lee, MD, has served as a speaker for Amgen and Alexion; is on the Advisory Board for Viridian; and is a consultant for Stoke, AstraZeneca, and Bristol Myers Squib. All other authors report no conflicts of interest.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram.
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