Severe Aqueous-Deficient Dry Eye Following Herpes Zoster Ophthalmicus With Periocular Inflammation: A Case Series

This series aimed to describe the clinical characteristics and course of severe aqueous-deficient dry eye (ADDE), a condition characterized by tear deficiency and reduced corneal sensation, following ophthalmic herpes zoster infection with periocular inflammation. Four cases of ADDE that developed after ophthalmic herpes zoster infection were retrospectively examined. Clinical data, including disease course, medical history, imaging findings, tear volume assessment, corneal sensitivity testing, and treatment outcomes, were collected. Our patients exhibited severe tear deficiency, significant corneal hypoesthesia, and serious corneal complications, accompanied by persistent ocular pain despite reduced corneal sensation. Imaging studies revealed dacryoadenitis in two cases and suggested severe periocular inflammation in all cases. Persistent superficial punctate keratopathy (SPK) was observed in all patients, with complications including corneal ulcers, perforation, persistent epithelial defects, and filamentary keratitis. Neuropathic pain was believed to contribute to persistent ocular pain. Treatment with topical rebamipide, autologous serum eye drops, punctal plugs, and eyelid closure effectively managed corneal epithelial damage and associated complications. Herpes zoster-induced dacryoadenitis and corneal sensory nerve damage probably contributed to ADDE pathogenesis. Given the potential for severe corneal complications, careful long-term monitoring is crucial in these patients.