What If You Have Shingles Around Or In Your Eye
Community Eye Health
If shingles are in the eye, they most often show up inside the eyelid and on the surface or the eyeball, says Rebecca Taylor, MD, an ophthalmologist with Nashville Vision Associates in Tennessee.
On the surface, says Dr. Taylor, they mainly show up on the cornea, which is the clear dome of tissue that covers your iris , and the conjunctiva the clear tissue that covers the whites of your eye and the inside of your eyelid.
If shingles is in these places, she says, youll be prescribed eye drops with steroids to calm the lesions, and lubricating tears for comfort.
If you have had shingles in your eye, says Taylor, your eye doctor will monitor you for 3 to 12 months to make sure that your eye is returning to health and that no new developments have occurred. You may also be encouraged to have a yearly eye exam until otherwise instructed by your eye doctor.
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.
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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.
What To Do If You Think You Have Shingles
If you suspect that you have shingles, its important to visit a healthcare professional as soon as possible. According to the American Academy of Dermatology , treating shingles within the first 72 hours gives you the best chance of minimizing complications like nerve pain.
Antiviral medications or other medications only available by prescription can shorten the duration of your shingles or lessen the severity.
If a cream or other topical isnt reducing your pain, its a good idea to visit your doctor again. They may recommend trying another treatment like capsaicin cream instead of lidocaine.
If a product is making your symptoms worse, its important to stop taking it right away.
You may be able to reduce your symptoms using home remedies while youre waiting to see a healthcare professional. These include applying a wet cold compress or taking a cool bath.
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Doctors Of Osteopathic Medicine
A Doctor of Osteopathic Medicine focuses on medicine geared to treat the whole person. A DO emphasizes the importance of preventing medical conditions and maintaining long-term physical well-being.
People may seek DO care because they want to work on overall wellness rather than treat a single condition. Individuals with shingles may choose a DO because they need help with a range of symptoms.
One technique that a DO might suggest for someone with shingles is known as myofascial release . This involves stretching and releasing different parts of the body to rebalance tissues.
Shingles can cause pain due to uncomfortable rashes. Balancing tissue function through myofascial release may provide relief in some cases.
A DO may also use:
- facilitated positional relief
- balanced ligamentous tension
- reciprocal inhibition
Shingles can cause pain and discomfort throughout the body. An experienced DO may be able to increase a persons comfort by restoring tissue balance and connectivity.
How Is Shingles Diagnosed
Your healthcare provider will do a complete physical exam and ask about your medical history, specifically about whether you have ever had chickenpox.
Your healthcare provider will likely know right away that it is shingles based on the unique rash. The rash usually appears one area on one side of the body or face. It appears as red spots, small fluid- or pus-filled vesicles, or scabs.
The healthcare provider may also take skin scrapings for testing.
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Why Doesnt Having Chickenpox Earlier In Life Provide Immunity Against Having Shingles Later
After having chickenpox, your body doesnt rid your system of the virus. Instead, the virus stays in a portion of the spinal nerve root called the dorsal root ganglion. In most people, the virus simply stays there quietly and doesnt cause problems. Scientists arent always sure why the virus gets active again, but they know stress can be a cause.
What If I Have Shingles And A Poor Immune System
If you have a poor immune system and develop shingles then see your doctor straightaway. You will normally be given antiviral medication whatever your age and will be monitored for complications. People with a poor immune system include:
- People taking high-dose steroids. per day for more than one week in the previous three months. Or, children who have taken steroids within the previous three months, equivalent to prednisolone 2 mg/kg per day for at least one week, or 1 mg/kg per day for one month.)
- People on lower doses of steroids in combination with other immunosuppressant medicines.
- People taking anti-arthritis medications which can affect the bone marrow.
- People being treated with chemotherapy or generalised radiotherapy, or who have had these treatments within the previous six months.
- People who have had an organ transplant and are on immunosuppressive treatment.
- People who have had a bone marrow transplant and who are still immunosuppressed.
- People with an impaired immune system.
- People who are immunosuppressed with HIV infection.
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Can You Spread Shingles Over Your Own Body
Shingles cannot be spread over different areas of your body. For example, if you have an active shingles rash on your back, the fluid from the blisters cannot cause a new rash on your arm.
However, the fluid could potentially spread VZV to someone else if theyve never had chickenpox or received the chickenpox vaccine.
One caveat here is that some people can develop disseminated herpes zoster, which is when the shingles virus causes a rash over multiple areas of the body. This can happen in people who have weakened immune systems from autoimmune disease, cancer, or immunosuppressant medications.
Is The Zostavax Vaccine Still Being Used
Yes. The CDC, however, recommends Zostavax for adults age 60 and older, but not routinely for people aged 50 to 59. Zostavax is given as a single-dose shot versus the two-dose shot for Shingrix. Zostavax is less effective than Shingrix in preventing shingles and postherpetic neuralgia .
You can consider Zostavax if you are allergic to Shingrix or if Shingrix is unavailable because of supply shortage and you want some immediate protection from a possible case of shingles and/or postherpetic neuralgia. Because its a weakened live vaccine, it may be dangerous if you have cancer, HIV, or take steroids, chemotherapy or other medications that suppress your immune system. Ask your healthcare provider if the Zostavax vaccine is an option for you.
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Am I At Risk For Shingles
Everyone who has had chickenpox is at risk for developing shingles. Researchers do not fully understand what makes the virus become active and cause shingles. But some things make it more likely:
- Older age. The risk of developing shingles increases as you age. About half of all shingles cases are in adults age 60 or older. The chance of getting shingles becomes much greater by age 70.
- Trouble fighting infections. Your immune system is the part of your body that responds to infections. Age can affect your immune system. So can HIV, cancer, cancer treatments, too much sun, and organ transplant drugs. Even stress or a cold can weaken your immune system for a short time. These all can put you at risk for shingles.
Most people only have shingles one time. However, it is possible to have it more than once.
Where Does Shingles Come From
When you have chickenpox as a child, your body fights off the varicella-zoster virus and the physical signs of chickenpox fade away, but the virus always remains in your body. In adulthood, sometimes the virus becomes active again. This time, the varicella-zoster virus makes its second appearance in the form of shingles.
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Treatment Of Pain After Shingles
Treatment for people with PHN may include:
- Nerve blocks: Local anesthetic or alcohol injected directly into the nerve affected
- Thoracic epidural injections: Local injection in the space around the spinal cord
- Antidepressant medications: Such as amitriptyline
- Membrane stabilizers: Such as gabapentin
- Capsaicinapplication: Topical cream applied to the affected area
What Does It Mean To Let Shingles Run Its Course
This refers to the typical course a shingles rash takes, even with antiviral treatment:
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How Is Shingles Treated
Specific treatment for shingles will be determined by your healthcare provider based on:
- Your age, overall health, and medical history
- How long the shingles have been present
- Extent of the condition
- Your tolerance for specific medicines, procedures, or therapies
- Expectations for the course of the condition
- Your opinion or preference
There is no cure for shingles. It simply has to run its course. Treatment focuses on pain relief. Painkillers may help relieve some of the pain. Antiviral drugs may help lessen some of the symptoms and reduce nerve damage. Other treatments may include:
- Creams or lotions to help relieve itching
- Cool compresses applied to affected skin areas
- Antiviral medicines
- Anticonvulsants
How Can I Treat Shingles Naturally
The shingles virus affects the nerves, which is why a skin rash only appears in a specific area of the body rather than all over. However, nerve pain is still possible even after the shingles rash has disappeared. If the nerve fibers are damaged, they are unable to send messages from your skin to your brain. This complication of shingles is called postherpetic neuralgia and it can cause severe pain, lasting months or even years.
Postherpetic neuralgia is more common in the following patients:
- Adults over the age of 50
- Patients with another medical condition, like diabetes
- Those who experienced a severe shingles rash
- Those who experienced a shingles rash on the face or torso
- Patients who didnt begin shingles treatment within 72 hours of symptoms appearing
Besides chronic pain, symptoms of postherpetic neuralgia include depression, insomnia, suppressed appetite, and attention deficits. Fortunately, there are home remedies, over-the-counter products, and prescription medications that offer pain relief to these symptoms. Heres a long list of treatments:
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Which Groups To Avoid If You Have Shingles
Pregnant women who have not had chickenpox should avoid people with shingles. See the separate leaflet called Chickenpox Contact in Pregnancy for more details. Also, if you have a poor immune system , you should avoid people with shingles. These general rules are to be on the safe side, as it is direct contact with the rash that usually passes on the virus.
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.
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When Should You Call For Help
or seek immediate medical care if:
- You have a new or higher fever.
- You have a severe headache and a stiff neck.
- You lose the ability to think clearly.
- The rash spreads to your forehead, nose, eyes, or eyelids.
- You have eye pain, or your vision gets worse.
- You have new pain in your face, or you can’t move the muscles in your face.
- Blisters spread to new parts of your body.
- You have symptoms of infection, such as increased pain, swelling, warmth, or redness.
Watch closely for changes in your health, and be sure to contact your doctor if:
- The rash has not healed after 2 to 4 weeks.
- You still have pain after the rash has healed.
What Are The Complications Of Shingles
Symptoms of shingles usually dont last longer than 3 to 5 weeks. However, complications can happen. The main complications that can result from shingles include:
- Postherpetic neuralgia . The most common complication of shingles is called postherpetic neuralgia . This continuous, chronic pain lasts even after the skin lesions have healed. The pain may be severe in the area where the blisters were present. The affected skin may be very sensitive to heat and cold. If you had severe pain during the active rash or have impaired senses, you are at increased risk for PHN. The elderly are also at greater risk. Early treatment of shingles may prevent PHN. Pain relievers and steroid treatment may be used to treat the pain and inflammation. Other treatments include antiviral drugs, antidepressants, anticonvulsants, and topical agents.
- Bacterial infection. A bacterial infection of the skin where the rash happens is another complication. Rarely, infections can lead to more problems, such as tissue death and scarring. When an infection happens near or on the eyes, a corneal infection can happen. This can lead to temporary or permanent blindness.
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Preventing The Virus Spreading
If you have the shingles rash, do not share towels or flannels, go swimming, or play contact sports. This will help prevent the virus being passed on to someone who has not had chickenpox.
You should also avoid work or school if your rash is weeping and cannot be covered.
Chickenpox can be particularly dangerous for certain groups of people. If you have shingles, avoid:
- women who are pregnant and have not had chickenpox before as they could catch it from you, which may harm their unborn baby
- people who have a weak immune system, such as someone with HIV or AIDS
- babies less than one month old, unless it is your own baby, in which case your baby should have antibodies to protect them from the virus
Once your blisters have dried and scabbed over, you are no longer contagious and will not need to avoid anyone.
Antiviral Medicines For Shingles
Antiviral medicines used to treat shingles include aciclovir, famciclovir and valaciclovir. An antiviral medicine is not a cure for shingles, it does not kill the virus but works by stopping the virus from multiplying. So, it may limit the severity of symptoms of the shingles episode.
An antiviral medicine is most useful when started in the early stages of shingles . However, in some cases your doctor may still advise you have an antiviral medicine even if the rash is more than 72 hours old – particularly in elderly people with severe shingles, or if shingles affects an eye.
Antiviral medicines are not advised routinely for everybody with shingles. As a general rule, the following groups of people who develop shingles will normally be advised to take an antiviral medicine:
- If you are over the age of 50. The older you are, the more risk there is of severe shingles or complications developing and the more likely you are to benefit from treatment.
- If you are of any age and have any of the following:
- Shingles that affects the eye or ear.
- A poorly functioning immune system .
- Shingles that affects any parts of the body apart from the trunk .
- Moderate or severe pain.
If prescribed, a course of an antiviral medicine normally lasts seven days.
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When Should I Seek Emergency Care For A Shingles Rash
While most cases of shingles are mild, several potential complications may require emergent care:
- Facial rash. A shingles rash on the face is concerning because eye involvement can lead to blindness. This requires an urgent assessment from an ophthalmologist.
- Loss of hearing or facial movement. Rarely, shingles can lead to hearing loss or facial nerve paralysis.
- Disseminated herpes zoster. This widespread shingles rash can also affect your organs. It requires hospitalization with intravenous antiviral treatment.
- Fever. Shingles in addition to fever can be concerning. It may mean you have a superimposed bacterial infection, which could require antibiotics and close observation.
- Confusion or seizures. Shingles in addition to confusion or seizures could indicate brain inflammation, which requires hospitalization for IV antiviral treatment and close monitoring.
Dr. Megan Soliman is an ABMS board certified internal medicine physician whose main focus in her clinical practice is patient advocacy. Her research interests include adverse effects of medications and herbal supplements. Soliman is enthusiastic about bread and butter medicine, which includes treating patients with the most common diseases. She also has a passion for reaching underserved communities, including both U.S. and international rural communities.