Hutchinson's Sign in Herpes Zoster Ophthalmicus
Bibliographic record
Abstract
TOPIC: Although traditionally associated with herpes zoster ophthalmicus (HZO), the predictive significance of Hutchinson's sign (HS), or nasociliary nerve involvement, for ocular complications has recently been debated. We conducted a systematic review and meta-analysis to evaluate the association between HS and ocular involvement in HZO. CLINICAL RELEVANCE: Clinicians across various medical specialties frequently utilize HS to risk-stratify patients presenting with cutaneous signs of HZO, yet recent uncertainty has emerged regarding its clinical value. METHODS: We searched Ovid MEDLINE, Embase, and Cochrane Library from inception to March 2025 for observational studies reporting on HS in HZO, stratified by the presence of ocular involvement. Paired independent reviewers conducted study screening, data extraction, and risk of bias assessment using the Risk of Bias in Non-randomized Studies of Exposures tool. The primary outcome was the odds ratio (OR) for ocular involvement comparing patients with versus without HS, calculated using a random-effects meta-analysis. The secondary outcomes included pooled sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: Fourteen studies (7 retrospective and 7 prospective) were included. Hutchinson's sign was associated with increased odds of ocular involvement compared with the absence of HS (78%, 308/393 in patients with HS vs. 34%, 539/1576 in patients without HS; OR = 6.51, 95% confidence interval = [4.09, 10.34], P < 0.01; 12 studies, 1969 patients, Grading of Recommendations Assessment, Development, and Evaluation [GRADE] = Low). Hutchinson's sign demonstrated moderate sensitivity (52.6%; 12 studies, 847 patients, GRADE = Very Low), high specificity (89.2%; 12 studies, 1122 patients, GRADE = Low), moderate accuracy (67.8%; 12 studies, 1969 patients, GRADE = Very Low), high PPV (88.5%; 13 studies, 997 patients, GRADE = Low), and moderate NPV (59.8%; 12 studies, 1576 patients, GRADE = Very Low) for ocular involvement. Risk of bias was predominantly moderate, and certainty of evidence ranged from very low to low. CONCLUSION: Very low to low-certainty evidence supports HS as a predictive factor for ocular involvement in HZO. Its high specificity and PPV reinforce its clinical utility in risk stratification; however, its absence alone does not reliably exclude ocular complications. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.040 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.011 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".