Reactivation of Varicella-Zoster Virus Keratitis after Recombinant Herpes Zoster Vaccination: A Case Report and Literature Review

Introduction: VZV keratitis following recombinant herpes zoster vaccination is rare, and its underlying mechanisms remain poorly understood. Sporadic cases of ocular inflammatory reactivation have been reported after vaccination, particularly in patients with a history of herpes zoster infection. Case Presentation: A 68-year-old woman with a history of trigeminal herpes zoster without prior corneal involvement developed VZV keratitis two months after receiving the recombinant herpes zoster vaccine (Shingrix®). The condition progressed to neurotrophic keratitis, requiring advanced ocular surface therapy, including autologous serum and topical insulin, with favorable visual and symptomatic outcomes. Conclusion: Reactivation of VZV keratitis after herpes zoster vaccination is an uncommon but clinically relevant event. Ocular reactivation may occur even in patients without previous corneal involvement and may lead to chronic complications, supporting the need for close ophthalmologic follow-up in patients with a history of herpes zoster infection.