The significance of the determination of lymphocytes with clinical manifestation of ophthalmic zoster sine herpete

Tatsuya Marumoto¹, Yoshimune Hiratsuka^2,3, Akira Murakami<sup>2

1</sup>Marumoto Eye Clinic, Yokohama, Japan; ²Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan; ³Department of Management Sciences, National Institute of Public Health, Wako, Japan

Objective: To examine the significance of VZV-IgG (IgG) enzyme immunoassay (EIA) and the determination of peripheral blood lymphocyte counts in the diagnosis of ophthalmic zoster sine herpete (ophthalmic ZSH).

Method: Clinical case-control study with a sample of 65 patients with ophthalmic ZSH (16 males and 49 females; mean age 56 ± 18 years) in whom pressure elicited pain in tender points of Valleix (tender points of sites at which the trigeminal nerve appears subcutaneously). A total of 41 healthy controls (17 males and 24 females, mean age 48 ± 21 years) were also recruited. In each group, IgG and lymphocyte count were determined upon receiving the consent of patients. Multiple logistic regression analysis was used to evaluate the factors associated with diagnosis of ophthalmic ZSH. Odds ratios and 95% confidence intervals (CI) were determined for each variable.

Results: Lymphocyte count in the patients with ophthalmic ZSH was significantly low, though there were no significant differences in age, gender, and IgG between the two groups. Multiple logistic regression analysis revealed that lymphocytes pose a significant prognostic factor, and in case of 1,800 lymphocytes/µl or more, the odds ratio to less than1,800 lymphocytes/µl was 0.29 (95% CI: 0.12–0.72).

Conclusion: Patients with orbital pain should be suspected as having ophthalmic ZSH as this allows for the determination of lymphocyte counts after tender points were confirmed. The swift diagnosis of ophthalmic ZSH and the administration of antiviral drugs from an early stage improve the subjective symptoms of the patient and is regarded as necessary to reduce the risk of severe complications.

Keywords: ophthalmic ZSH, lymphocytes count, VZV-IgG, tender points of Valleix, orbital pain, antiviral drugs