Ophthalmic shingles, also known as herpes zoster ophthalmicus (HZO), is a serious medical condition affecting the eye and surrounding facial areas. It arises from the reactivation of the varicella-zoster virus (VZV), the same virus responsible for chickenpox. Early recognition and prompt medical attention are important for managing its effects.
What Causes Shingles in the Eye?
Ophthalmic shingles occurs when the varicella-zoster virus, dormant in nerve cells after a chickenpox infection, reactivates. The virus remains inactive within sensory ganglia for many years. When immunity to VZV declines, often due to aging, illness, or a weakened immune system, the virus can travel along nerve pathways and cause shingles.
When VZV reactivates in the trigeminal ganglion, it can affect the ophthalmic nerve, one of the three branches of the trigeminal nerve. This nerve transmits sensations from the forehead, upper eyelid, and eye structures. Reactivation in this nerve branch leads to shingles symptoms in and around the eye. Common triggers include increased age, stress, certain medications, and medical conditions such as cancer, HIV, or diabetes.
Recognizing the Signs
Ophthalmic shingles often begins with symptoms preceding any rash, such as tingling, burning, or pain in the affected area, along with headache or fever. These initial sensations occur on one side of the face, aligning with the nerve pathway where the virus is reactivating. The pain associated with shingles can range from mild to severe.
Following these initial symptoms, a painful, blistering rash commonly appears on the forehead, upper eyelid, or around the eye. Hutchinson’s sign, a rash on the tip or side of the nose, suggests a higher likelihood of eye involvement because the nasociliary nerve, which supplies the eye, also innervates this area. Eye-specific symptoms include pain in or around the eye, redness, eyelid swelling, blurred vision, sensitivity to light (photophobia), and watery discharge. These symptoms usually affect only one eye.
Medical Diagnosis and Treatment
Diagnosing ophthalmic shingles involves a thorough physical examination, including assessment of the rash and surrounding skin. An ophthalmologist will perform a comprehensive eye examination, often utilizing a slit lamp. This examination helps identify any eye involvement, such as inflammation of the cornea or other internal structures.
Immediate medical attention is important if ophthalmic shingles is suspected, as early treatment can reduce severity and lower complication risk. Primary treatment involves antiviral medications like acyclovir, valacyclovir, or famciclovir, which reduce viral replication. These medications are most effective when started within 72 hours of rash onset. A typical course lasts 7 to 10 days. Supportive treatments may also be prescribed, including pain relievers and specific eye drops, such as steroid drops to reduce inflammation or cycloplegic drops to relieve pain and spasm, as directed by an ophthalmologist.
Potential Eye Complications
If ophthalmic shingles is not treated promptly, it can lead to serious eye complications. Inflammation of the cornea (keratitis) is a common complication that can cause scarring and affect vision. Uveitis, inflammation of the middle layer of the eye, can also occur and may lead to increased eye pressure or glaucoma.
Other potential complications include retinal necrosis, a severe condition affecting the retina, and chronic conjunctivitis. These complications can result in permanent vision loss, chronic eye pain, and scarring within the eye. Post-herpetic neuralgia (PHN) is a persistent nerve pain that can linger for months or years after the rash resolves, and can specifically affect the eye area. Ongoing monitoring by an ophthalmologist is important due to the potential for delayed complications and the need for long-term management in some cases.
Preventing Ophthalmic Shingles
Vaccination is a primary method for preventing shingles, including the form that affects the eye. The shingles vaccine, Shingrix, is recommended for healthy adults aged 50 years and older. It is administered in two doses, typically 2 to 6 months apart. Adults aged 19 years and older who have weakened immune systems are also recommended to receive the vaccine.
The vaccine significantly reduces the risk of developing shingles and, if shingles does occur, it lessens the severity of the illness and the likelihood of complications like post-herpetic neuralgia and ophthalmic involvement. Shingrix has shown high efficacy, with studies indicating over 90% effectiveness in preventing shingles in adults aged 50 and older with healthy immune systems, and similar effectiveness against post-herpetic neuralgia. Even individuals who have previously had shingles or received an older shingles vaccine should consider getting Shingrix for added protection.