Herpes zoster stromal keratitis after varicella vaccine booster in a pediatric patient

Cornea. 2014 Sep;33(9):988-9. doi: 10.1097/ICO.0000000000000199.


Purpose: In this study, the case of a healthy pediatric patient who presented with herpes zoster (HZ) stromal keratitis after vaccination with live attenuated varicella vaccine (Varivax) and subsequent booster is described.

Method: This is a retrospective case review.

Results: A 6-year-old girl with no medical history presented with HZ ophthalmicus and stromal keratitis. She had received the original Varivax vaccine at 1 year of age and a booster 1 year before presentation. Topical prednisolone acetate was started with subsequent improvement in inflammation and visual acuity. However, the patient was unable to be completely tapered off the steroids because of reactivation.

Conclusions: HZ ophthalmicus with stromal keratitis is a rare but potentially damaging manifestation of the varicella zoster virus in the pediatric population. Long-term data regarding reactivation rates in the post-vaccination era are still limited. Close follow-up is needed to ensure resolution of the infiltrates, and reactivation may require long-term steroid therapy.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Topical
  • Chickenpox Vaccine / adverse effects*
  • Child
  • Corneal Stroma / drug effects
  • Corneal Stroma / virology*
  • Corneal Ulcer / drug therapy
  • Corneal Ulcer / etiology*
  • Female
  • Glucocorticoids / therapeutic use
  • Herpes Zoster Ophthalmicus / drug therapy
  • Herpes Zoster Ophthalmicus / etiology*
  • Herpesvirus 3, Human / pathogenicity
  • Humans
  • Immunization, Secondary / adverse effects*
  • Ophthalmic Solutions
  • Prednisolone / analogs & derivatives
  • Prednisolone / therapeutic use
  • Vaccination


  • Chickenpox Vaccine
  • Glucocorticoids
  • Ophthalmic Solutions
  • prednisolone acetate
  • Prednisolone