Exacerbation of zoster interstitial keratitis after zoster vaccination in an adult.

T wo different forms of varicella-zoster virus (VZV) immunizations are available. Children are vaccinated with Varivax to reduce the risk of primary infection with VZV, and Zostavax is given to reduce the risk of VZV reactivation in adults. In a large prospective trial of adults older than 60 years, vaccination with Zostavax was shown to decrease the incidence of herpes zoster by 51.3% as well as to decrease the severity of the cases that occurred. Ocular complications of the childhood vaccine have been previously described, but the US Food and Drug Administration and the Centers for Disease Control and Prevention do not recognize a history of herpes zoster ophthalmicus (HZO) immunogenic stromal keratitis (interstitial keratitis [IK]) or iritis as a relative contraindication to adult vaccination. We describe a patient with marked worsening of VZV IK after receiving the Zostavax vaccine.