Herpes Ophthalmicus After Facial Augmentation With Fillers

Abstract

As the population ages, the incidence of herpes zoster otherwise known as shingles increases. The occurrence of zoster in facial cosmetic patients may be increasing. We experienced the complication of reactivation of the herpes virus presenting as herpes ophthalmicus after injection with dermal fillers. An extensive literature review was undertaken to identify other cases of zoster after facial procedures. We were able to identify only 1 other case similar to ours. The literature addressed viral prophylaxis for herpes simplex but there is little discussed about the need of prophylaxis for zoster. We were able to identify a potential for an increase in the incidence of zoster as the aging population is seeking more invasive corrective treatments. A subsequent rise in zoster is reported correlating with the use of childhood vaccination for varicella. It is postulated that low levels of exposure provide some protective effect through antigen exposure. Without that exposure, patients are at higher risk of reactivation as the varicella vaccination was not available at the time. Consensus appears to be lacking on how to appropriately prophylax patients for risk of zoster reactivation.