Shingles in the eye (herpes zoster): Symptoms, complications, and treatments

By: Dr. Victor Marchione | Eye Health | Saturday, April 15, 2017 - 06:00 AM

Shingles in the Eye (Herpes Zoster): Symptoms, Complications, and Treatments Herpes zoster, which is commonly known as shingles, causes painful blisters near the nerves on one side of your body, but what many people don’t realize is that it can also cause damage to your eyes, including an eye infection, blurry vision, and swollen eyelids.

If you haven’t had chickenpox, then you can’t get herpes zoster, but if you have had chickenpox, it is a possibility. Herpes zoster or shingles is, in fact, a virus. Early diagnosis can reduce the risk of complications such as eye infection, blurry vision, and swollen eyelids.

A herpes zoster eye infection can be unpleasant, so catching it early and getting treatment is always preferable. In the early stages of a herpes zoster eye infection, a person might feel a sharp stabbing pain or possibly an itching or burning sensation on the forehead, eyelid, or even the sides of the nose. A fever, headache, and chills may also be experienced early on. Three to five days later, blisters may appear on the forehead or inside the eyelids and tip of the nose. The blisters start out clear with a red base, but over the next seven days, the clearness turns to puss or might even bleed. The virus can impact just the skin, or the following can happen:

  • Red, painful watery eyes
  • Swollen eyelids
  • Sensitivity to light
  • Blurry vision
  • Feeling as if you have something in your eye

In some cases, people only have eye symptoms and no blisters.

You can have shingles on the eyelid and around the eye that are very irritating. They cause swelling, redness, and pain. Shingles that involve the eye are called herpes zoster ophthalmicus.

When a person is getting over shingles that are on their body, the blisters start to crust over, and the pain and irritation tend to disappear over a period of one to three weeks. When the shingles virus damages a nerve, you can have pain or tingling for months or even years after the actual blister rash has healed.

Research suggests that people with weakened immune systems, those who are under stress, and older individuals are at a higher risk of getting shingles. Herpes zoster eye infections seem to be random and not necessarily associated with stress or immune weakness, according to current data, but studies continue on the subject.

The common initial presentation of shingles is tingling or burning pain with no rash, often on one side of the body. It may be accompanied by a low fever, headache, and flu-like symptoms. The pain is often found in the truncal area of the body, which typically includes:

  • Waist
  • Back
  • Chest
  • Ribcage

After the first couple of days, the rash will appear on the side of the body where the initial pain and tingling was felt. The rash will always be on one side of the body or face as the shingles virus travels along the nerve path. This initial rash will become painful blisters a couple of days after and may eventually pop or rupture, leading to slight bleeding. Over time, the blisters will start to crust over and heal. Singles may last on average two to six weeks.

Shingles in the eye: Risk factors and complications

As I am sure you can imagine, shingles in the eye is not something you want to experience. It can be terribly uncomfortable. The varicella zoster virus, as it is called, does come with complications, including potential eye difficulties.

In about two percent of shingles cases where eyes are involved, there are complications. In some cases, these problems can lead to loss of vision. For example, eye inflammation beginning with fever, headache, decreased vision, pain, and droopy eyelid needs to be addressed. If a person has blisters or lesions near an eye, they should seriously consider seeing an eye specialist.

Retinal inflammation can cause a condition called acute retinal necrosis. The retina is located in the back of the eye. It senses light and controls our vision. Retinal inflammation normally starts with blurry vision and pain in one eye. In some people, it later impacts the other eye. If treated quickly, it can be improved.

Simply having the chickenpox as a child puts you at risk for developing shingles later in life. It is estimated that about one in five people who have had chickenpox will develop the rash. The primary reason is that the varicella zoster virus stays dormant in the nerve cells near the spine, and can reactivate when we reach a more advanced age. The following puts you at increased risk for getting shingles:

  • Having chicken pox as a child
  • Greater than 50 years old, to due the immune system becoming weaker over time
  • Have a weak immune system because of infectious diseases, such as HIV, AIDS, or Cancer
  • Are taking medicine that inhibits the immune system. Some examples include chemotherapy or radiation therapy
  • Increased stress levels

Shingles eye infections diagnosis and treatment

Eye infections associated with shingles are normally detected by signs and symptoms, including erosion on the outer layer of the cornea. An eye doctor diagnoses this during an exam using eye drops containing a yellow dye and a blue light. The erosion linked to shingles usually has a tree-branching pattern to it. An eye doctor will also take a close look at eye tissues. In some cases, a culture will be taken to confirm the diagnosis. Most individuals diagnosed are older than 60 years of age. If a shingles eye infection is neglected for too long, it may have serious consequences, such as going blind.

Oftentimes, initial shingles treatment for the eye is eye drop medications. Oral antiviral medications are also prescribed, but they do not cure eye infections or shingles, but reduce the chances of the problem happening again. But in general, shingles is a disease that will disappear on its own. The use of painkillers and analgesics may help give some relief to unbearable pain

When eye pressure is impacted due to swelling, a pressure-lowering medication may also be suggested. And inflammation may require medications such as steroid treatments.

Most shingle eye infections that are on the outer layer of the cornea get better within a few weeks of antiviral treatment.

Sometimes, herpes zoster can leave scarring on the cornea, but this is something that can be corrected with surgery.

It is also a good idea to prevent the spread of the virus if living with others. During the blister phase, the rash is very infections, to the point where direct contact or indirect contact from towels or commonly used items may be a mode of transmission. Keeping the affected area washed and dressed in clean bandages every day will reduce the likelihood of transmitting the virus.

Preventing shingles in the eye

Many people who experience frequent, reoccurring herpes zoster eye infections are prescribed a low-dose antiviral drug on a daily basis. It has been known to reduce recurrences. You do have to have a detailed discussion with your doctor to determine if this is a safe option for you. There is also a shingles vaccine. It is available to people who are 50 years of age or older. The vaccine can help prevent or lessen the symptoms of shingles. It is not a treatment once a person actually has shingles.

If you do end up with singles, it is wise to avoid contact with anyone who has never gotten chickenpox. This is especially important during the blister phase, as this is when you are most contagious. If someone close to you who has never had chickenpox catches the varicella zoster virus, they will not get shingles but, instead, chickenpox. Those with shingles infections should do the following:

  • Stay away from pregnant women and those with weakened immune systems. These individuals may suffer from severe complications from the virus
  • Keep the rash covered to prevent spread
  • Avoid scratching the rash
  • Always wash your hand after touching the rash.

Research continues to come up with ways to get rid of the varicella zoster virus that causes shingles and the eye infections that can accompany the condition. In the meantime, maintaining good overall health, including a strong immune system and lowering stress, may help you keep the nasty virus at bay.


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Related Reading:

Shingles risk can increase with inflammatory bowel disease (IBD): Study

Is shingles contagious? Shingles risk during pregnancy, transmission, and prevention

Sources:

http://www.healthline.com/health/eye-health/shingles-in-the-eye#symptoms2
http://www.shinglesexpert.org/shingles-in-eyes

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