Herpes zoster ophthalmicus with prolonged viral shedding following COVID-19 infection

Herpes zoster ophthalmicus (HZO) is usually a self-limited condition in which treatment decisions are guided by clinical features. We present a case of a 77-year-old female with HZO following COVID-19 infection and prolonged varicella-zoster virus (VZV) shedding. Despite antiviral therapy and clinical improvement, VZV DNA remained detectable by polymerase chain reaction (PCR) for at least 2 months after symptom onset. The disease had an extended duration, with aberrant lesions beyond the dermatome and residual atrophic scarring. This case raises questions regarding the clinical significance of prolonged viral shedding and the need for widespread vaccination efforts. Moreover, various therapeutic approaches involving different dosages and durations of antiherpetic medications have been adopted despite the lack of established guidelines to support a universal protocol, necessitating careful consideration of clinical and virological monitoring. Nevertheless, further studies are needed to determine whether PCR follow-up may have a role in guiding treatment decisions for herpes zoster.