What Is Herpes Zoster Of The Eye
Herpes zoster, commonly known as “shingles,” is a viral disease that causes a painful skin rash consisting of small fluid-filled blisters that form scabs and can leave permanent scars. When it involves the region that surrounds your eye, it is called herpes zoster ophthalmicus and can cause serious eye problems including corneal ulcers, inflammation, and glaucoma.
Other Complications Of Shingles
If the shingles rash appears around the eye or forehead, it can cause eye infections and temporary or permanent loss of vision. If the shingles virus attacks the ear, people may develop hearing or balance problems. In rare cases, the shingles virus may attack the brain or spinal cord. These complications can often be prevented by beginning treatment for shingles as soon as possible.
Can Eye Shingles Cause Blindness
For example, eye shingles can cause:
A corneal dendrite which may lead to a scar
In the most severe cases of eye shingles, a patient may need a corneal transplant.
Eye shingles is not contagious. It cannot be spread to another person.
However, a person who has shingles-related rash anywhere on their body can transmit chickenpox virus to someone who hasnt already had chickenpox or been vaccinated for the condition.
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Can Shingles Cause Chronic Pain
In some people, the pain of shingles may linger for months or even years after the rash has healed. This pain, due to damaged nerves in and beneath the skin, is known as postherpetic neuralgia. Others feel a chronic itch in the area where the rash once was. In severe cases, the pain or itching may be bad enough to cause insomnia, weight loss, or depression.
How To Treat Shingles On The Face
Shingles on the face may require referral to a specialist for treatment, such as an ophthalmologist.
There are also medications that can ease symptoms. When taken early, they can help the blisters to clear more quickly and decrease pain. Treatment is most effective if you take it within 3 days of your symptoms starting.
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What Are The Complications Of Shingles
After the shingles rash has disappeared, you might continue to have nerve pain in that same area. Postherpetic neuralgia can last for months or years and become quite severe.
More than 10% of people who get shingles develop postherpetic neuralgia. Researchers dont know why some people get postherpetic neuralgia and others dont. It may be that nerves become more sensitive or that the virus may be invading and damaging the central nervous system.
Other complications include:
- Other types of nerve issues like numbness or itching.
- A bacterial infection of the shingles rash.
- Eye and ear inflammation if the rash is near these organs.
What Causes Eye Shingles
Before we take a closer look at shingles affecting the eye , lets talk about what causes shingles in the first place: the chickenpox virus.
As an adult, you may have a hazy memory of spending a week in bed, your itchy body dotted in pink calamine lotion as you binged on daytime TV and ate popsicles by the box.
The blisters may be long gone, but the chickenpox virus still lies dormant in your body.
About one in three U.S. adults will get shingles when the varicella-zoster virus that sparked their childhood chickenpox reactivates in the body, according to Mayo Clinic.
Shingles typically starts out as a band of tenderness or tingling on your skin and then turns into a painful rash.
People will tell you, It was the worst pain I ever had, Rapuano says.
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What Does A Mild Case Of Shingles Look Like
Not everyone with shingles will develop a blistering rash. A mild case of shingles may include a red rash without blisters. The shingles rash and blisters are distinct characteristics of the illness. Mild cases of shingles do not usually cause headaches, fever, or fatigue.
Whether mild or severe, pain is the most common symptom of shingles. Most people describe a deep burning, throbbing, or stabbing sensation. The pain usually subsides within 30 days.
Shingles On The Face: Complications And Treatment
Potential for serious complications is very real.
The red rash and lesions associated with shingles can erupt anywhere on the human body. It all depends on which nerves are affected by the reactivation of the varicella zoster virus that remained in the body after an earlier case of chickenpox.
Although the front and back of the torso are the usual sites of the rash, the face will be affected when the virus reactivates in the trigeminal nerve, which handles face and motor functions. When this happens, the patient is at risk for potentially serious complications like facial pain, numbness, tingling, or paralysis damage to the eyes, and hair loss.
The shingles rash generally appears on just 1 side of the affected body part, and the face is no exception. The fluid-filled blisters can extend to cover the mouth, eye, ear, forehead, nose, and scalp. Early diagnosis and treatment can help limit the length of the infection and its complications, including postherpetic neuralgia.
Two of the most serious threats from shingles on the face are herpes zoster ophthalmicus and herpes zoster oticus, which involves the ear.
Herpes zoster ophthalmicus , or ocular shingles, is a growing health risk in the United States, according to an article published in the American Academy of Ophthalmologys EyeNet Magazine.1 It reports that cases are on the rise and account for approximately 10% of all shingles cases.1
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Symptoms Of Shingles In The Eye
When you have shingles in the eye, the blistering rash will form on your eyelids, forehead, and possibly on the tip or side of your nose. This rash might show up at the same time as the skin rash, or weeks after the skin blisters have gone away. Some people only have symptoms in their eye.
Along with the rash, you might have:
- burning or throbbing pain in your eye
- redness around and in the eye
You might also have swelling in parts of your eye, such as:
- your retina, which is the light-sensitive layer in the back of your eye
- your cornea, which is the clear layer in the front of your eye
If you have one or more of these symptoms, call your primary care doctor or an eye doctor for an appointment. The sooner you get treatment, the less likely it is that youll have long-term complications.
Shingles In The Back Of The Eye
Shingles involving the retina or optic nerve structures found at the back of the eye typically is not associated with a skin rash or other symptoms at the eye surface. This type of shingles infection is called viral retinitis and occurs much less commonly than HZO. But it can significantly damage the retina through a combination of infection and inflammation. Viral retinitis can take the form of acute retinal necrosis or progressive outer retinal necrosis .
In contrast to patients with HZO or other forms of shingles that are associated with a skin rash, patients with ARN are often middle-aged and generally healthy. Diagnosis of ARN requires a careful eye exam by an ophthalmologist, and a sample may be collected from the inside of the eye for testing to confirm that the infection is caused by the varicella zoster virus. In mild cases, ARN can be treated with oral antiviral medications, with or without injections of antiviral medications into the eye. In more severe cases, or if there is no improvement with oral medications and intraocular injections, these infections are treated with intravenous antiviral medications until the infection starts to improve.
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Can You Go Blind With Shingles
Yes, shingles can cause blindness. Shingles may cause inflammation at the front or back of the eye .4
Shingles may also cause viral retinitis if the inflammation occurs at the back of the eyes . Keratitis occurs in about 50% of all shingles cases, whereas viral retinitis is a less common complication.5
If shingles in the eye are left untreated, they may also cause increased intraocular pressure pressure in the eyes . Keratitis, retinitis, and glaucoma can damage your eyes, ultimately causing permanent vision loss.
Early treatment of eye shingles using antiviral drugs will prevent or reduce the risk of complications that can cause blindness.
You Cannot Get Shingles From Someone With Chickenpox
You cannot get shingles from someone with shingles or chickenpox.
But you can get chickenpox from someone with shingles if you have not had chickenpox before.
When people get chickenpox, the virus remains in the body. It can be reactivated later and cause shingles if someones immune system is lowered.
This can be because of stress, certain conditions, or treatments like chemotherapy.
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Diagnosis Of Shingles In The Eye
Your doctor should be able to diagnose shingles just by looking at the rash on your eyelids, scalp, and body. Your doctor might take a sample of fluid from the blisters and send it out to a lab to test for the varicella-zoster virus.
An eye doctor will examine:
- help the rash fade more quickly
Starting the medicine within three days after your rash appears can help you avoid long-term shingles complications.
To reduce swelling in your eye, your doctor might also give you a steroid medicine in the form of a pill or eye drops. If you develop postherpetic neuralgia, pain medicine and antidepressants can help relieve the nerve pain.
Do You Need To Stay Away From Children People Who Are Pregnant Have Cancer Or Anyone With A Weak Immune System After You Get The Zostavax Vaccine
According to the CDC, its safe to be around babies and young children, pregnant women or anyone with a weakened immune system after you get the Zostavax vaccine. Even though the Zostavax vaccine contains a weakened live varicella-zoster virus, the CDC says theres no documented case of a person getting chickenpox from someone who has received the Zostavax vaccine. And remember: You cant get shingles unless youve already had chickenpox.
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How Long Does Shingles On The Face Last
According to the National Institute on Aging , many cases of shingles take 35 weeks to heal.
If you experience a chronic infection, you may have recurrent pain and other symptoms, such as paresthesias, lasting more than 4 weeks. This could last months to years.
However, the outlook and recovery time will vary according to the person and their condition.
Shingles Vaccine Is The Best Prevention
The best way to prevent shingles, including shingles of the eye, is with a shingles vaccine. The Zostavax live shingles vaccine is no longer used in the US. Shingrix is a newer, more effective, and non-live shingles vaccine. Shingrix is a two-dose vaccine recommended for adults over age 50. It is more than 90% effective at preventing shingles. Unfortunately, the shingles vaccine does not treat shingles or post-herpetic neuralgia the vaccine is effective only as a prevention strategy.
About the Author
Miriam Barshak, MD, Contributor
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Can You Get Shingles In The Eye
Its most common to get the shingles rash on your chest, back or legs but you can get shingles on the face and eye, Rapuano says. About 15% of cases involve shingles in the eye area, he says.
However, theres a difference between having shingles around the eye and having shingles in the eye, which doctors refer to as eye involvement, Rapuano says. A patient can have shingles around the eye area without the eye itself being involved, he says.
About half of people who have shingles on the forehead or nose will also have eye involvement.
Ocular shingles typically occurs in one eye on the same side of the face as the rash. It typically occur after the shingles rash on the body has resolved, Rapuano says.
A patient who has had shingles on the face may feel like theyre healing well but then notice a symptom such as redness in the eye. When this happens, patients need to see an eye doctor right away, Rapuano says.
What Are The Risk Factors For Recurring Shingles
People dont know what causes recurring shingles, but certain factors increase your chances of getting shingles again.
People with weakened immune systems are more likely to get shingles again. One study determined that the rate of shingles recurrence was among people with compromised immune systems. This is about 2.4 times higher than for those who didnt have compromised immune systems.
You may have a compromised immune system if you:
- are getting chemotherapy or radiation therapy
- have organ transplants
- are taking high doses of corticosteroids like prednisone
Additional risk factors include:
- longer-lasting and more severe pain with the first case of shingles
- pain for 30 days or more with the first case of shingles
- being over the age of 50
Having one or more blood relatives with shingles may also increase your risk of getting shingles.
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Zoster Sine Herpete : Shingles Without The Rash
It is possible for a person to develop shingles without being affected by the rash, although this is rare. When shingles occurs without the rash being present, this is called zoster sine herpete .
When shingles occurs without a rash, the first symptoms of the condition may involve:
- A feeling of numbness in a certain area
- An itchy, burning sensation
- Generalized aches
- Hypersensitivity to touch
When shingles is present, even without the rash, sensations will be concentrated in a specific area of the body â commonly the face, neck, one side of the torso or the eyes. However, in the absence of the shingles rash, zoster sine herpete may still rarely lead toneurological and visceral diseases, such as inflammation of the brain , Varizella pneumonia, paralysis of the facial nerves and problems related to keeping oneâs balance or problems with hearing.
Because shingles shares characteristics with many other conditions, including herpes simplex, impetigo, dermatitis herpetiformis and contact dermatitis, it can easily be confused with these conditions. In cases where a rash is not present, a laboratory test will usually be necessary to establish the presence of the varicella zoster virus in the body.
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What Does The First Signs Of Shingles Look Like
Early symptoms of shinglesfirst signs
Consequently, what are the very first signs of shingles?
These signs and symptoms may include:
- Pain, burning, numbness or tingling.
- Sensitivity to touch.
- A red rash that begins a few days after the pain.
- Fluid-filled blisters that break open and crust over.
Also Know, what can be mistaken for shingles? Shingles can sometimes be mistaken for another skin conditions, such as hives, psoriasis, or eczema. The shingles rash also tends to clear up in a few weeks. Rashes due to eczema and psoriasis may last longer. A shingles rash is also usually a lot more painful than other rashes.
In this regard, can you have a mild case of shingles?
Depending on where shingles develops, it could also cause symptoms like hiccups or even loss of vision. For some people, the symptoms of shingles are mild. They might just have some itching. For others, shingles can cause intense pain that can be felt from the gentlest touch or breeze.
What do shingles look like on skin?
The characteristic rash of shingles rash starts as small blisters on a red base. New blisters continue to form for three to five days. The blisters appear along the path of individual nerves in a specific ray-like distribution and appear in a band-like pattern over an area of skin.
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Shingles Of The Eye Can Cause Lasting Vision Impairment
- By Miriam Barshak, MD, Contributor
Shingles, or herpes zoster, is a viral infection known for its characteristic painful, burning, or itchy rash. This rash appears along a particular affected nerve, for example in a band on one side of the chest or abdomen that extends around to the back. In fact, the name shingles comes from cingulum, the Latin word for girdle, belt, or sash.
Shingles is caused by reactivation of the varicella zoster virus, the virus that causes chickenpox. After the initial chickenpox infection resolves the virus lives on in nerves all over the body, but is kept in check by the immune system. The risk of shingles therefore increases with any process that can weaken the immune system, including age, illness, and immune-suppressing medications. About one million cases of shingles occur in the US each year.
Up to 20% of shingles episodes involve nerves of the head, where the infection can affect various parts of the eye, including the eyelid, the eye surface, and the deeper portions of the eye. Viral infection of the eye can cause pain, drainage, redness, and sensitivity to light. In some cases it can lead to vision impairment, including blindness.
Preventing Shingles In The Eye
When it comes to shingles and especially ocular shingles prevention is the best medicine.
Fortunately, there are two shingles vaccines:
Shingrix A fairly new vaccine, Shingrix is recommended for adults ages 50 and over. You get Shingrix in two doses two to six months apart, and its more than 90% effective in protecting you from shingles and post-herpetic neuralgia. Protection stays strong for at least four years after you get vaccinated.
Zostavax An older vaccine for shingles, Zostavax is a live vaccine that is less effective but may be used in healthy adults ages 60 and up if theres a reason they cant have Shingrix administered. For example, someone who is allergic to a component of Shingrix may opt for Zostavax.
The availability of a newer, more effective vaccine should prevent even more shingles outbreaks. We recommend the vaccine for all of our patients, Dr. Rapuano says.
WORRIED YOU MIGHT HAVE EYE SHINGLES ?Find an optician near you and schedule an appointment.
Page published on Sunday, 24 May 2020
Page updated on Wednesday, 2 February 2022
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