Shingles, a viral infection caused by the varicella-zoster virus (VZV), is the same pathogen responsible for chickenpox. After a person recovers from chickenpox, VZV remains dormant in nerve cells. Years or even decades later, the virus can reactivate, leading to shingles. While shingles commonly manifests as a rash on the trunk, it can also affect the eyes, a condition specifically known as ophthalmic shingles or herpes zoster ophthalmicus (HZO).
Ophthalmic Shingles: What It Is and How It Manifests
Ophthalmic shingles occurs when the dormant varicella-zoster virus reactivates in the trigeminal nerve, a cranial nerve that transmits sensation from the face, including the eye and forehead, to the brain. The ophthalmic branch of this nerve, when affected, leads to symptoms in and around the eye. This causes inflammation and a characteristic rash along the nerve pathway.
The initial signs often include a tingling, burning, or painful sensation on the scalp, forehead, or cheek, typically on one side of the face. Within a few days, a red, painful rash emerges, developing into small, fluid-filled blisters that eventually scab over. This rash commonly appears on the forehead, eyelid, and around the eye.
Beyond the skin rash, ophthalmic shingles can cause various ocular symptoms. These include eye pain, redness, a feeling of something in the eye, sensitivity to light (photophobia), blurred vision, and sometimes discharge. Hutchinson’s sign, a rash or blisters on the tip or side of the nose, indicates a higher likelihood of significant ocular complications. This sign suggests the virus has affected a nerve branch connected to both the nose and internal eye structures.
Potential Complications and Long-Term Impact
Untreated or severe ophthalmic shingles can lead to serious eye complications. One common ocular complication is conjunctivitis, an inflammation of the clear membrane covering the white part of the eye. More severe issues include keratitis, which is inflammation of the cornea, the clear front surface of the eye. This can result in corneal scarring, irregular surface, or even ulceration and perforation.
Inflammation can also extend deeper into the eye, causing uveitis (inflammation of the middle layer of the eye) or iritis (inflammation of the iris). These inflammations can increase eye pressure, leading to glaucoma, which damages the optic nerve and can result in permanent vision loss. In rare cases, retinal necrosis, the death of retinal tissue, can occur. These complications can lead to severe vision loss or blindness if not managed.
A significant long-term impact of shingles, including ophthalmic shingles, is post-herpetic neuralgia (PHN). PHN is chronic nerve pain that can persist for weeks, months, or even years after the rash clears. This pain, often described as burning or throbbing, can occur in the ophthalmic region. The risk of PHN increases with age and the severity of the initial rash.
Diagnosis and Treatment Approaches
Prompt diagnosis and treatment are essential for managing ophthalmic shingles and reducing severe complications. A healthcare professional typically diagnoses shingles based on the characteristic appearance of the rash. If the rash is on the face, especially near the eye, an immediate ophthalmologist consultation is vital. The ophthalmologist will conduct a thorough eye examination, often using a slit-lamp.
Antiviral medication is the primary treatment for ophthalmic shingles. Acyclovir, valacyclovir, and famciclovir are commonly prescribed. To be most effective, treatment should ideally begin within 72 hours of the rash’s onset. A typical course lasts 7 to 10 days.
Supportive treatments may also be necessary. Steroid eye drops or oral corticosteroids can reduce inflammation inside the eye, requiring careful ophthalmologist monitoring. Pain relievers manage discomfort, and artificial tears alleviate dry eye symptoms. In some cases, prolonged antiviral therapy, like valacyclovir for a year, can reduce the risk of new or worsening eye disease.
Preventive Measures
Vaccination is the most effective way to prevent shingles, including ophthalmic shingles. The shingles vaccine, Shingrix, is recommended for most adults. The CDC recommends two doses for adults aged 50 and older, and for adults 19 and older with weakened immune systems due to their higher risk of shingles and complications.
Shingrix is a non-live, recombinant vaccine. It is over 90% effective in preventing shingles and post-herpetic neuralgia in adults aged 50 and older. Its protection is durable, with high efficacy demonstrated for at least seven years. Even individuals who have previously had shingles or received an older shingles vaccine should consider getting Shingrix.