Shingles, also known as herpes zoster, is a viral infection from the reactivation of the varicella-zoster virus, the same pathogen responsible for chickenpox. After a chickenpox infection, the virus remains dormant in nerve tissues. This dormant virus can reactivate later, causing shingles. While shingles can manifest on any part of the body, its appearance on the face, particularly around the eye, is referred to as herpes zoster ophthalmicus (HZO). Recognizing HZO is important due to the potential for significant eye-related complications.
Appearance of Shingles Around the Eye
Shingles around the eye often begins with subtle indicators. Individuals may first experience a tingling or burning sensation on the scalp, forehead, or cheeks, sometimes appearing a few days before any visible rash. This initial phase can then progress to redness and swelling of the skin, commonly affecting the eyelids, forehead, or the area around the nose.
Within a few days, a distinct rash emerges, characterized by clusters of small, fluid-filled blisters (vesicles) on a red base. These blisters ooze fluid before drying and forming crusty scabs. The rash typically appears on one side of the face in a dermatomal pattern, not extending beyond the midline.
The rash can appear on the forehead, upper eyelid, and sometimes the side or tip of the nose. When lesions appear on the tip of the nose, it is known as Hutchinson’s sign, which can signal a higher likelihood of eye involvement. Eyelid swelling can be pronounced, occasionally temporarily obscuring the eye. Some individuals may experience pain from shingles even without a visible rash.
Associated Symptoms
Shingles affecting the eye is frequently accompanied by non-visual symptoms that contribute to the overall discomfort. Pain is a prominent feature, often described as a burning, throbbing, sharp, or stabbing sensation, and it can sometimes precede the rash. Individuals might also report other sensory changes, such as tingling, itching, numbness, or an increased sensitivity to touch in the affected facial area.
Systemic symptoms can manifest, including a headache, a low-grade fever, and general fatigue. Sensitivity to light, medically termed photophobia, is another symptom that can occur, suggesting irritation or inflammation within the eye.
Potential Eye Complications
When shingles manifests around the eye, it carries the potential for serious complications, especially if the virus affects the delicate structures of the eye. One common complication is inflammation of the conjunctiva, known as conjunctivitis, which can cause redness, burning, and discharge. More concerning is keratitis, an inflammation of the cornea, the clear front surface of the eye.
Keratitis can lead to blurred vision, pain, and heightened light sensitivity. If not managed appropriately, severe keratitis can result in corneal scarring, ulcers, or even perforation, potentially affecting vision permanently. Inflammation can also occur within the eye, affecting the iris, a condition called iritis or anterior uveitis. This internal inflammation can cause eye pain, redness, and sensitivity to light.
A rise in the pressure inside the eye can also occur due to iritis, potentially leading to glaucoma. Glaucoma, if left unaddressed, can damage the optic nerve and result in vision loss. Less common, more severe complications include inflammation of the retina, known as retinitis, or the optic nerve, called optic neuritis. These conditions can lead to significant and potentially permanent vision impairment.
When to Seek Medical Attention
Anyone who suspects shingles around the eye should seek immediate medical attention from a doctor or an eye specialist. Swift diagnosis and treatment are important to prevent severe eye complications and reduce the duration and intensity of the symptoms.
Treatment with antiviral medications, ideally initiated within 72 hours of the rash appearing, can significantly lower the risk of eye involvement and long-term issues. Even if the rash has not visibly affected the eye, or if only sensory symptoms are present, a medical evaluation is still necessary to determine viral involvement. An eye specialist can examine the eye and prescribe treatments to manage inflammation, swelling, and pain, thereby working to preserve vision.