Treatments For Ocular Shingles
The treatment for shingles around the eye is the same as treatment for shingles on any other area of the body. Three antiviral drugs have been approved for treatment of shingles.
These drugs can:
Shorten the length of a shingles outbreak.
Make shingles less painful.
Reduce the chances of post-herpetic neuralgia, a complication that can cause ongoing pain and sensitivity after the rash resolves.
In addition to these overall benefits, prompt treatment with antiviral medication can cut in half the incidence of eye disorders in ocular shingles.
Without antiviral medication, 50% of ocular shingles patients will develop eye disorders compared with only 25% of patients who take the medication.
Its crucial to begin taking antiviral medication within 72 hours of the outbreak of the skin rash. It should be started as soon as possible after the rash starts, Rapuano says.
The prodromal phase of herpes zoster ophthalmicus includes an influenza-like illness with fatigue, malaise, and low-grade fever that lasts up to one week before the rash over the forehead appears.3 About 60 percent of patients have varying degrees of dermatomal pain in the distribution of the ophthalmic nerve.4 Subsequently, erythematous macules appear along the involved dermatome, rapidly progressing over several days to papules and vesicles containing clear serous fluid and, later, pustules. These lesions rupture and typically crust over, requiring several weeks to heal completely.5
Early & Late Symptoms
The symptoms in the early stages of shingles in the eye include
- Tingling, or stabbing pain
- You are also likely to have itchiness on the skin around your eyes
- Burning sensation around your eyes also results from itchiness
- For children or teenagers, fever is also a common sign
- You are also likely to have extra light sensitivity
Late symptoms include the following
- An itchy rash around the eye and on your forehead
- Painful blisters on the eye lids
- Eye lid may be paralyzed
- Numbness of the skin on the forehead
- Frequent Tearing and Watering of the eyes
- On rare occasion, you may have blurry vision
- Irritation and swelling of the eyelids
If you have blurred vision after treating shingles, it is advisable that you see your doctor. There is a possibility that there is an underlying condition which causes the blurry vision. The blisters that form around your eyes may change the color to yellow.
As mentioned above, blisters are one of the symptoms of shingles in the eye. At a later stage, these blisters may begin to ooze. This may lead to formation of scabs around the eye.
Recovery From Eye Shingles
Recovery time varies by patient and the specific case, Rapuano says. If the inflammation is mild and the treatment is pretty aggressive, then symptoms may start getting better within days, he says.
At some point, the optician may try to slowly wean the patient off steroids. But a recurrence of inflammation may signal a need to keep using steroid eye drops.
Many patients will need to be on low-dose steroids for years, if not forever, Rapuano says.
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Outlook For People With Shingles In The Eye
Your shingles rash should heal within one to three weeks. Symptoms around your face and eyes can sometimes take up to a few months to heal.
In the early stages of the disease, your doctor will check you every few days. After youve received treatment for the infection, youll probably need to see your eye doctor every 3 to 12 months to check for glaucoma, scarring, and other long-term problems that can affect your vision.
Treatment Of Herpes Zoster Ophthalmicus
Antiviral drugs taken by mouth
Corticosteroid eye drops
Eye drops to keep the pupil dilated
As with shingles anywhere in the body, early treatment with an antiviral drug such as acyclovir, valacyclovir, or famciclovir can reduce the duration of the painful rash. When herpes zoster infects the face and threatens the eye, treatment with an antiviral drug reduces the risk of eye complications.
Corticosteroids, usually in eye drops, may also be needed if the eye is inflamed.
Eye drops, such as cyclopentolate or atropine, are used to keep the pupil dilated, to help prevent a severe form of glaucoma, and to relieve pain.
The treatment of herpes zoster has three major objectives: treatment of the acute viral infection, treatment of the acute pain associated with herpes zoster and prevention of postherpetic neuralgia. Antiviral agents, oral corticosteroids and adjunctive individualized pain-management modalities are used to achieve these objectives.
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Incidence And Pathophysiology Of Herpes Zoster
Herpes zoster is a commonly seen disorder one fifth of the population will present with the disease during their lifetime. The reported incidence varies from 2.2 per 1000 to 3.4/1000 people per year. Herpes zoster develops mainly in elderly people: its incidence in people aged over 80 is about 10 in 1000/year.1,2 It is caused by reactivation of the varicella zoster virus . In temperate climates, primary infection with this virus usually occurs before the age of 10 and manifests itself clinically as chickenpox . The virus then becomes latent, nestling in the sensory ganglia. Later it may become active again, spread to the corresponding dermatome by means of a spinal or cerebral nerve , and generate the characteristic unilateral vesicular exanthema. The accompanying inflammation of the sensory nerve and skin damage are supposedly responsible for the acute pain.3 Reactivation of the virus is linked to a diminished virus specific and cell mediated immunity, which is related to age. Immunocompromised patients also run an increased risk of developing herpes zoster . In contrast to other herpes infections, recurrence of herpes zoster is relatively rare .1 Since it has not yet been proved that herpes zoster is provoked by any serious underlying pathological condition ,4 a search for possible risk factors is not warranted in otherwise healthy patients in whom herpes zoster develops.
Box 1: A 70 year old woman tells her storystory
Treatment Of Shingles In The Eye
However, if you do end up with shingles, McLaughlin says the most effective treatment is antiviral medication.
The sooner you can start it, the better. Antiviral medications are most effective when started within 72 hours. These meds will reduce the duration and severity of your infection, as well as lower your risk of having those complications of eye damage, blindness, and postherpetic neuralgia.
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Rebooting The Nervous System
Itslike restarting a computer, Dr. Rosenquist says. When its running slowly oracting weird, you restart it. We are trying to turn that nerve off. When itcomes back on, hopefully it will send an appropriate transmission as opposed toa pain transmission.
Treatmentoptions for PHN patients include:
Patientswith refractory PHN rarely need opioid pain medication. However,you should be evaluated by a physician. We cant make a blanket statement abouttreatment. It is individualized, she says.
Shingles In The Front Of The Eye
Shingles can affect the cornea, the curved, transparent dome of tissue at the front of the eye. This is called keratitis, and it can occur as a complication of herpes zoster ophthalmicus , which refers to shingles with a rash that typically involves one side of the upper face, forehead, and scalp. More than half of patients with HZO may have keratitis.
If you have shingles involving the upper face, forehead, or scalp area, it is important to see an ophthalmologist for a formal eye examination, whether or not you notice any eye symptoms. Keratitis usually develops within one month of the shingles rash and can lead to numbness of the cornea, scarring, additional infections, and more corneal damage, which can ultimately cause blindness.
HZO, like episodes of shingles on other areas of the body, is typically treated with oral antiviral medications to address the underlying viral infection. Treatment decreases the risk of later eye complications by about 40% to 60%. When started within 72 hours of the onset of symptoms, antiviral treatment also reduces the overall severity of the infection and the risk of post-herpetic neuralgia, a form of long-term pain that can occur after an episode of shingles.
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How Can You Prevent Spreading The Virus
You cant give shingles to someone else, but the varicella-zoster virus is very contagious. If you have shingles and you expose someone else who has not had chickenpox or the chickenpox vaccine, you can give them the virus. Theyll get chickenpox, not shingles, but this puts them at risk for shingles later on.
Youre contagious when your blisters are oozing, or after they break and before they crust over. Do the following to avoid spreading the virus to others:
- Keep your rash covered, especially when the blisters are active.
- Try not to touch, rub, or scratch your rash.
- Wash your hands thoroughly and often.
Avoid contact with people whove never had chickenpox or the chickenpox vaccine, especially:
How Do You Get Shingles In The Eye
Eye shingles, also called herpes zoster ophthalmicus or ophthalmic herpes zoster, is a painful rash in or around the eye. It also occurs in other areas, such as the face, forehead, and scalp.1
You may get shingles in the eye if youve previously contracted chickenpox, and the virus that causes it reactivates years later.2 Those vaccinated against chickenpox may also develop eye shingles later in life, although the risk is low.
Chickenpox is characterized by highly contagious fluid-filled blisters that spread all over the body and face. The symptoms last about 4 to 7 days.
After you recover from chickenpox, the virus stays dormant in the nervous system. However, it may reactivate in the trigeminal nerve years later, causing shingles in the eyes.
Ocular shingles are not contagious, but the virus can spread to another person who has never had chickenpox or been vaccinated against it. This can only happen if they come into contact with active blisters from another person. In this case, they will develop chickenpox and not shingles.
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How Long Does Shingles Last
Shingles blisters usually scab over in 7-10 days and disappear completely in two to four weeks. In most healthy people, the blisters leave no scars, and the pain and itching go away after a few weeks or months. But people with weakened immune systems may develop shingles blisters that do not heal in a timely manner.
What Is The Outcome For Someone Who Has Shingles
Most people get shingles once, but its possible to get it again.
If you have a healthy immune system, the blisters tend to clear in 7 to 10 days. The rash tends to go away completely within 2 to 4 weeks. The pain may last longer, but usually stops in 1 or 2 months.
For some people, the pain will last longer than the rash. When it does, its called postherpetic neuralgia , which can come and go or be constant. PHN can last for months, years, or the rest of your life. Treatment can help reduce the amount of pain you feel.
Be sure to tell your doctor if you continue to have pain. Treatment can help you feel more comfortable.
For anyone who has a shingles rash, the right self-care can help ease your discomfort. Youll find out what dermatologists recommend at, Shingles: Self-care.
ReferencesCenters for Disease Control and Prevention . About shingles. Page last reviewed 10/17/2017. Last accessed 4/1/2019.
Dooling KL, Guo A, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. Morb Mortal Wkly Rep 2018 67:103-8.
Madkan V, Sra K, et al. Human herpes viruses. In: Bolognia JL, et al. Dermatology. . Mosby Elsevier, Spain, 2008: 1204-8.
Straus SE, Oxman MN. Varicella and herpes zoster. In: Wolff K, Goldsmith LA, et al. Fitzpatricks Dermatology in General Medicine . McGraw Hill Medical, New York, 2008: 1885-98.
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How Shingles Can Get Into The Eyes
After the symptoms of chickenpox have cleared up, the virus lies dormant in the body. More specifically, the virus remains in the nerves. At any time, the virus can reactivate and cause shingles to develop.
When the virus reactivates in a nerve called the trigeminal nerve, it can cause shingles of the eye. The trigeminal nerve carries signals between the brain and several areas of the face, including the eye.
How Can You Care For Ocular Shingles At Home
- Make sure to follow the medical advice of your doctor regarding prescriptions
- Avoid scratching or picking at any blisters
- Use a cold compress to relieve pain and itching
- Wait until the blisters have healed before you have close contact with people and avoid anybody most at risk such as pregnant women, young babies and those with a weakened immune system. The blisters contain the chicken pox virus which can be spread
What Causes Shingles In The Eye
The varicella-zoster virus, the virus that causes chickenpox, lives in the nerves of people who have previously had chickenpox. It becomes herpes zoster ophthalmicus when it reaches the eye, and it can cause severe pain along with the notorious rash that accompanies shingles on other areas of the body.
The shingles virus does not always activate in people who have had chickenpox. When it does, the shingles rash most often appears along the back, ribs, and chest areas. Occasionally, it will show up in other areas, like the face or legs.
According to experts, the resulting weakened immune systems and stress have caused increased shingles cases, tripling them from 2004 to 2016. You cannot predict whether you will have eye shingles since the virus can travel over your body and appear in different areas.
Questions To Ask Your Doctor
- Ive had chickenpox. Am I at risk of developing shingles?
- What is the best treatment for my shingles?
- The pain from shingles isnt going away. What can I do to make myself more comfortable?
- Im on treatment for shingles. When should I call my doctor if things dont get better?
- I have shingles and my children havent had the chickenpox vaccine. Should I get them vaccinated?
- Is the shingles vaccine right for me?
- Are there any risks associated with the shingles vaccine?
- Will my post-herpetic neuralgia ever go away?
- If Ive never had the chickenpox, should I still get the shingles vaccination?
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Are There Treatments I Can Put On My Skin
You might find relief with topical treatments. You can talk to your doctor about:
Creams: Some of these contain capsaicin, the ingredient in cayenne pepper that gives it a kick. Examples are Capsin and Zostrix. You can buy this over the counter but make sure your doctor knows if you plan on using these.
Patches: Capsaicin is also in Qutenza, which is applied via a patch for one hour every 3 months. You need to visit the doctorâs office for this.
Painful Virus That Can Cause Vision Loss Is Affecting More Older Adults
by Christina Ianzito, AARP, May 15, 2019
En español | The side effects of the shingles virus can range from extremely unpleasant to nightmarish, especially when the virus affects the eye. Unfortunately, shingles of the eye is rising dramatically, according to researchers at the University of Michigan’s Kellogg Eye Center who found that the incidence has tripled since 2004.
The study results were presented at the 2019 Association for Research in Vision and Ophthalmology meeting in Vancouver recently and given how dramatic the findings are, says lead author Nakul Shekhawat, we are now looking at overall incidences of shingles in that time frame and seeing if there’s a similar pattern.”
Shingles is caused by the varicella-zoster virus, which first enters the body as chickenpox and never leaves. It stays dormant in sensory nerve roots, and in about one-third of us, reactivates later in life as shingles. Its most common early symptoms are itching, tingling or pain, followed by an angry red rash along the nerve path traveled by the virus the path depends on where the virus has been sleeping.
It often appears as an angry red rash on the torso, but about 20 percent of cases show up in the eye area on one side of the face typically with redness on and around the eyelid, and sometimes on the forehead and scalp.
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How Eye Shingles Are Treated
You do not have to endure shingles. With the help of your doctor, you can overcome the discomfort and help the outbreak to heal. You can also take some steps to reduce the frequency and severity of your outbreaks.
The key is to get help within three days of the start of an outbreak. That is the moment at which your immune system is still strong but could use a little boost. Antiviral medications can tamp down the virus and send it back to the nerve root, so you will feel a bit more comfortable.
You will still be at risk for future outbreaks, as shingles can’t be cured. But the treatment can keep the excruciating pain and damage at bay.
Your doctor may ask you to spend a few days in the hospital. You will get around-the-clock care for your outbreak, and your doctor can watch the infection carefully and step in if sight-stealing complications appear.
When you are released to your home, there are plenty of things you can do to ease your discomfort. The American Academy of Ophthalmology recommends:
- Cool compresses. A moist, damp towel placed over your closed eyes can relieve some of your pain.
- Painkillers. If your doctor agrees, you can use medications like aspirin to ease distress.
- Eye drops. Your doctor may suggest soothing drops to help your tissues knit back together.