Herpes zoster ophthalmicus despite shingrix immunization

Background: Herpes zoster ophthalmicus (HZO) is a reactivation of the varicella-zoster virus causing serious ocular and systemic complications, particularly in individuals with declining immunity. Case report: A 74-year-old male with a history of various chronic conditions was referred to an eye clinic due to herpes zoster affecting his right forehead and eye. Initial treatment included acetaminophen-hydrocodone, valacyclovir, and ofloxacin, with hypotensive agent added to manage elevated intraocular pressure. Follow-up visits showed improvement in lid swelling and eye pain, although his visual acuity initially worsened before eventually improving to near complete resolution, with corneal edema resolving with topical steroid and IOP stabilizing. The patient's treatment regimen was adjusted accordingly, with instructions to return for continued care until resolution. Conclusion: This case report highlights an unusual occurrence of HZO in an immunocompetent patient who had received Shingrix, emphasizing the need for awareness, early diagnosis, antiviral therapy, and tailored co-management approaches for effective care.