Risk of Herpes Zoster Ophthalmicus After COVID-19 Vaccination in a Large US Health Care Claims Database

center dot PURPOSE: Herpes zoster ophthalmicus (HZO) after COVID-19 vaccination has been reported in numerous case studies. However, no large-scale epidemiologic stud-ies have been conducted to date. The purpose of this study was to determine whether COVID-19 vaccination is as-sociated with an increased risk of HZO. center dot DESIGN: Retrospective before-and-after risk interval analysis.center dot METHODS: o Setting : OptumLabs Data Warehouse, a US national deidentified claims-based database. o Study Population : Patients without a prior history of HZO who received any dose of a COVID-19 vaccine from December 11, 2020, to June 30, 2021. o Intervention : Any dose of a COVID-19 vaccine in the defined risk periods. o Main Outcome Measure(s): HZO, defined by an In-ternational Classification of Disease 10th Revision code and a prescription or escalation of antivirals. In-cidence rate ratios (IRRs) were calculated to compare the risk of HZO in the risk intervals after vaccination with the risk of HZO during the control interval.center dot RESULTS: In total, 1,959,157 patients received a dose of a COVID-19 vaccine during the study period and met eligibility criteria. A total of 80 individuals without a prior history of HZO were included in the analysis be-cause they developed HZO in the risk or control pe-riod. Patients had a mean age of 54.0 years (SD = 12.3 years). There were 45 cases of HZO in the risk inter-val after COVID-19 vaccination. There was not an in - creased risk of HZO after vaccination with BNT162b2 (IRR = 0.90, 95% CI: 0.49-1.69, P = .74), mRNA-1273 (IRR = 0.74, 95% CI: 0.36-1.54, P = .42), or Ad26.COV2.S (IRR = 0.50, 95% CI: 0.07-2.56, P = .42).center dot CONCLUSIONS: This study found no evidence of in-creased risk of HZO after COVID-19 vaccination, pro-viding reassurance for patients and providers who may be concerned about the safety profile of the COVID-19 vaccines. (Am J Ophthalmol 2024;258: 139-144. (c) 2023 Elsevier Inc. All rights reserved.)