Louisiana Via Research Day Book 2026

Case Studies: Section 1

Case Studies: Section 1

Samreen Shah, MS, OMS-III 1 ; Ayorinde Cooley, MD, PhD 2 1 VCOM-Louisiana; 2 Willis Knighton Eye Institute – Shreveport, Louisiana 59 HERPES ZOSTER OPHTHALMICUS FOLLOWING RECOMBINANT ZOSTER VACCINE

Samreen Shah, OMS-III 1 ; Madeline Hay, DO 2 1 VCOM-Louisiana; 2 Meadows Eye – Las Vegas, Nevada 60 RECURRENT NODULAR ANTERIOR SCLERITIS SECONDARY TO LATENT TUBERCULOSIS

Context: Herpes zoster ophthalmicus (HZO) results from reactivation of latent varicella-zoster virus (VZV) within the ophthalmic division of the trigeminal nerve and accounts for 10–20% of herpes zoster cases. Although the recombinant zoster vaccine (RZV, Shingrix) has demonstrated greater than 90% efficacy in preventing herpes zoster, rare instances of VZV reactivation following vaccination have been reported. Recognition of post-vaccination HZO is critical due to its potential for vision-threatening complications. Report of Case: A 67-year-old male with a history of hypertension and hyperlipidemia presented with acute left-sided forehead pain, pruritus, and blurred vision one week after receiving the recombinant zoster vaccine. Examination revealed a vesicular, erythematous rash in a V1 dermatomal distribution involving the forehead, upper eyelid, and scalp, accompanied by conjunctival injection and tearing of the left eye. Visual acuity was 20/25 in the right eye and 20/40 in the left eye, with no evidence of anterior chamber inflammation or elevated intraocular pressure. Neurologic examination was unremarkable. The patient

was treated with oral valacyclovir 1 g three times daily for ten days, along with supportive ophthalmic therapy including artificial tears and cool compresses. At one-month follow up, symptoms had fully resolved and visual acuity returned to baseline without ocular complications. performed with search terms including “herpes zoster ophthalmicus,” “recombinant zoster vaccine,” and “VZV reactivation.” While RZV is a non-live vaccine, proposed mechanisms for post-vaccination reactivation include immune modulation and transient disruption of viral latency, particularly in older individuals with declining cell-mediated immunity. This case highlights the importance of maintaining clinical suspicion for HZO following vaccination and underscores the role of early antiviral therapy in preventing long-term ocular morbidity. Conclusions: A targeted literature review using PubMed and Google Scholar was

Context: Scleritis is a painful inflammatory disorder of the sclera that is frequently associated with systemic autoimmune disease but may also arise from infectious etiologies. Tuberculosis-related scleritis is uncommon and often presents without pulmonary or systemic symptoms, making diagnosis challenging. Failure to recognize an underlying infectious cause may lead to inappropriate immunosuppression and progression of disease. This case highlights the importance of considering latent tuberculosis infection in patients with recurrent anterior scleritis and atypical clinical features. Report of Case: A 54-year-old woman was referred for recurrent episodes of focal redness and burning pain in her left eye for approximately one year. The current episode was the most severe and was associated with photophobia. Previous flares had transiently improved with topical prednisolone acetate but recurred with diminishing response. Examination revealed focal temporal scleral injection with nodular elevation and marked tenderness to palpation that did not blanch with topical phenylephrine. The cornea was

clear, and the anterior chamber was deep and quiet. Optical coherence tomography of the macula and dilated fundus examination were unremarkable. The patient’s medical history was notable for type 2 diabetes mellitus and Hashimoto thyroiditis. Prior laboratory evaluation demonstrated a low-positive antinuclear antibody and positive rheumatoid factor IgM, with negative antineutrophil cytoplasmic antibodies, angiotensin-converting enzyme, lysozyme, HLA-B27, Lyme serologies, and HIV testing. She reported recent travel to Mexico approximately one year earlier but denied pulmonary symptoms or systemic constitutional complaints. Conclusions: The patient’s recurrent nodular inflammation, lack of sustained response to topical corticosteroids, and epidemiologic exposure prompted evaluation for infectious etiologies prior to initiating systemic immunosuppression. Interferon-gamma release assay testing returned positive, confirming latent tuberculosis infection. The patient was referred for medical management of latent tuberculosis and continued a corticosteroid taper with adjunctive nonsteroidal anti-inflammatory

therapy. Her ocular pain resolved, and follow-up examination demonstrated marked improvement of scleral inflammation without recurrence. This case underscores the importance of maintaining suspicion for infectious causes of anterior scleritis, even in the absence of systemic disease. Careful integration of exposure history, clinical course, and treatment response can prevent misdiagnosis and avoid potentially harmful immunosuppressive therapy.

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2026 Research Recognition Day