Abstract：
BACKGROUND: This study aimed to describe the clinical features of patients with orbital apex syndrome (OAS) as a complication of herpes zoster ophthalmicus (HZO) and to identify factors associated with poor visual acuity outcomes.
METHODS: We performed a systematic review and retrospective analysis of the clinical characteristics and outcomes of patients with OAS secondary to HZO reported in the literature over 42 years (1978-2020).
RESULTS: We analysed 21 cases, 20 of which were identified in the literature, together with our patient. Their median age was 65 years, with equal involvement in both sexes. The median onset of OAS due to HZO was 10 days (range 1-28 days). The median time of treatment initiation was five days (range 1-21 days). All patients presented with reduced visual acuity, complete ophthalmoplegia, and ptosis. Most patients (17/21, 80.95%) were treated with systemic antiviral and corticosteroid therapy. Three (3/21, 14.29%) patients were immunocompromised. Recovery for ophthalmoplegia (19/21, 90.48%) and ptosis (16/21, 76.19%) was good. Half of the patients (9/18, 50%) showed poor vision recovery. Starting treatment more than 72 h after HZO onset (p = 0.045) was more likely to cause poor vision recovery.
CONCLUSIONS: OAS is a rare, serious, and potentially late complication of HZO and continued observation up to and perhaps beyond four weeks is justifiable, if not encouraged. Early initiation of treatment with systemic antiviral and/or corticosteroids within 72 h of onset of HZO appears beneficial for the recovery of visual acuity.
METHODS: We performed a systematic review and retrospective analysis of the clinical characteristics and outcomes of patients with OAS secondary to HZO reported in the literature over 42 years (1978-2020).
RESULTS: We analysed 21 cases, 20 of which were identified in the literature, together with our patient. Their median age was 65 years, with equal involvement in both sexes. The median onset of OAS due to HZO was 10 days (range 1-28 days). The median time of treatment initiation was five days (range 1-21 days). All patients presented with reduced visual acuity, complete ophthalmoplegia, and ptosis. Most patients (17/21, 80.95%) were treated with systemic antiviral and corticosteroid therapy. Three (3/21, 14.29%) patients were immunocompromised. Recovery for ophthalmoplegia (19/21, 90.48%) and ptosis (16/21, 76.19%) was good. Half of the patients (9/18, 50%) showed poor vision recovery. Starting treatment more than 72 h after HZO onset (p = 0.045) was more likely to cause poor vision recovery.
CONCLUSIONS: OAS is a rare, serious, and potentially late complication of HZO and continued observation up to and perhaps beyond four weeks is justifiable, if not encouraged. Early initiation of treatment with systemic antiviral and/or corticosteroids within 72 h of onset of HZO appears beneficial for the recovery of visual acuity.
摘要：
背景：本研究旨在描述眼眶尖综合征（OAS）作为眼带状疱疹（HZO）并发症的临床特征，并确定与视力不良结果相关的因素。
方法：我们对42年（1978-2020年）文献报道的HZO继发OAS患者的临床特征和结局进行了系统评价和回顾性分析。
结果：我们分析了21例，其中20个在文献中被确定，和我们的病人一起。他们的平均年龄是65岁,两性平等参与。由于HZO引起的OAS的中位发作为10天(范围1-28天)。治疗开始的中位时间为5天(范围1-21天)。所有患者视力下降，完全眼肌麻痹,和上眼睑。大多数患者（17/21，80.95％）接受全身抗病毒和皮质类固醇治疗。3例（3/21，14.29%）患者免疫功能低下。眼肌麻痹（19/21，90.48％）和下垂（16/21，76.19％）恢复良好。一半的患者（9/18，50％）表现出视力恢复不良。在HZO发作后超过72小时开始治疗（p=0.045）更有可能导致视力恢复不良。
结论：OAS是一种罕见的，严肃,HZO的潜在晚期并发症和持续观察可能超过四周是合理的，如果不鼓励。在HZO发作的72小时内早期开始全身性抗病毒和/或皮质类固醇治疗似乎有利于视力的恢复。
方法：我们对42年（1978-2020年）文献报道的HZO继发OAS患者的临床特征和结局进行了系统评价和回顾性分析。
结果：我们分析了21例，其中20个在文献中被确定，和我们的病人一起。他们的平均年龄是65岁,两性平等参与。由于HZO引起的OAS的中位发作为10天(范围1-28天)。治疗开始的中位时间为5天(范围1-21天)。所有患者视力下降，完全眼肌麻痹,和上眼睑。大多数患者（17/21，80.95％）接受全身抗病毒和皮质类固醇治疗。3例（3/21，14.29%）患者免疫功能低下。眼肌麻痹（19/21，90.48％）和下垂（16/21，76.19％）恢复良好。一半的患者（9/18，50％）表现出视力恢复不良。在HZO发作后超过72小时开始治疗（p=0.045）更有可能导致视力恢复不良。
结论：OAS是一种罕见的，严肃,HZO的潜在晚期并发症和持续观察可能超过四周是合理的，如果不鼓励。在HZO发作的72小时内早期开始全身性抗病毒和/或皮质类固醇治疗似乎有利于视力的恢复。
