What Does Shingles In The Eye Look Like

What Does Shingles Look Like

My shingles rash looked like someone had put a cigarette out on my eyelid. Frankly, I bet that would be less painful.

You would have thought by now I wouldve caught on but I never really realized that young people can get shingles. It just never crossed my mind. If I had simply done an internet search of my symptoms, it wouldve been obvious what I had.

According to Healthline:

You may begin to notice pink or red blotchy patches on one side of your body. These patches cluster along nerve pathways The rash quickly develops fluid-filled blisters similar to chickenpox. They may be accompanied by itching. New blisters continue to develop for several days. Blisters appear over a localized area and do not spread over your whole body.

Shingles also commonly has a rash that wraps around half of your waist, which people sometimes call the shingles belt or shingles girdle. Lovely. Id never heard of that, but I am also not over 70, and I assume these terms are more popular in that age bracket.

Developing shingles on your face, like I did, is common. Its also common to get them on your neck and torso though there are lots of other possibilities. And no matter where they look truly ugly and disgusting. More importantly, those blisters hurt. Its deep down nerve pain.

Heres what my shingles looked like around my eye :

So I didnt catch all those initial symptoms of shingles, but my doctor did.

Yeah, youve got shingles, my doctor told me.

Who Is At Risk

If youve had chickenpox, you are more susceptible as you age. About 50% of people who live to age 85 will have had some shingles event in their lives. Shingles can develop for a variety of reasons, especially for those:

• Over the age of 50, with increasing risk with each decade
• With a weakened immune system, such as those with cancer, HIV, transplant recipients, or patients receiving chemotherapy
• With an autoimmune disease

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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.

Summary points

Box 1: A 70 year old woman tells her storystory

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Examination By The General Practitioner

In ophthalmic zoster, diagnostics in general practice is restricted to history taking and a physical examination. The diagnostic possibilities during the prodromal phase are manifold until the typical skin signs become manifest. Doctors should always be on the alert for involvement of the eye. The appearance of skin lesions along the side of the nose, which represents the dermatome of the nasociliary nerve, is a useful prognostic factor for subsequent ocular inflammation in patients with acute ophthalmic zoster .16 General practitioners are often advised to focus their attention only on the tip of the nosethe dermatome of the external branch. The nasociliary dermatome, however, is more extensive and also affects the skin at the inner corner of the eye and the root and side of the nose .17

Psoriasis Forms Red Patches On The Skin

Psoriasis is an autoimmune disease that is easy to confuse with the shingles rash. As with the shingles virus, psoriasis forms red patches on the skin, according to Johns Hopkins Medicine. One type of psoriasis pustular can lead to the development of blisters. Areas of skin affected by psoriasis often develop into silvery scales on the scalp, elbows, knees, and lower back. Treatment can help control the condition.

Self-care for shingles at home includes:

• applying calamine lotion or other creams to soothe the skin and relieve pain
• cleaning the rash area gently to prevent bacterial infection
• placing cool compresses on blisters to lessen pain and help the blisters heal
• drinking plenty of water and other healthy liquids
• reducing stress as much as possible, such as walking every day and eating nutritious food
• resting, contact your doctor if pain is making it difficult to sleep

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Shingles In Eye Without Rash

The pain, itching, and irritation of shingles may develop even without rash. Though primarily a painful rash is the most visible sign of shingles, shingles in eye may occur without rash in some people.

Before the rash, you may notice other symptoms such as burning pain and sensitive skin around eye. You are also like to experience itching, tingling in eye, constant aching and in some cases deep shooting pain inside your eye. Some people may experience fever, chills and stomach upset.

When a painful rash is the characteristic of shingles, the rash will often start as small painful fluid filled blisters. With eyes shingles, the blisters will continue to form for 2 to 4 days. The blisters may appear along the eyelids or spread to the tip and sides of the nose.

Similar to the rash and painful blister formed by chicken pox, the blister eventually burst and start to ooze. They will then crust over and heal. At this stage, the virus is very contagious. It can easily be spread to those not vaccinated or immune to the virus

Shingles without can be hard to diagnoses. Early medical diagnosis and treatment is required in such cases to reduce the risk of the virus spreading. Early treatment may also help reduce the risk of complication associated with varicella virus.

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.

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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.

What Are The Side Effects

Shingrix can make the area where you get the shot swell or feel sore. Other effects include:

• Many people who get the vaccine have muscle aches, headaches, or feel tired.
• About 1 in 4 people have a fever or an upset stomach.

Younger people are more likely to have these side effects, and they typically last 2 or 3 days.

Itâs also possible to have an allergic reaction to an ingredient in the vaccine. If you have problems breathing, feel your face or throat swelling, or feel weak or dizzy after the shot, call 911 and get medical help right away.

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What You Should Know About Shingles

You may not remember having the itchy, painful welts caused by chickenpox. But according to the Centers for Disease Control and Prevention , 99.5 percent of people born before 1980 were infected at one point or another. Anyone who has been infected is at risk for shingles.

When chickenpox infections fade, the virus that caused them does not. Chickenpox is caused by the varicella-zoster virus , and it’s a member of the herpes family. Like most herpes-based illnesses, VZV never really goes away. Instead, it lies dormant within your body.

VZV rests within your nerves, and during a shingles outbreak, the virus triggers inflammation and pain along a nerve band. The CDC says one in three people will get shingles. Most have just one outbreak, but some have repeated problems.

Mayo Clinic says shingles can cause more than pain. The condition can also cause:

• Persistent fatigue.
• Sensitivity to light.

Typically, people with shingles will experience blisters along just one small area that wraps around the torso. But any part of the body served by nerves can get hit with shingles. Symptoms last for about two weeks before fading away.

How Is Shingles In The Eye Diagnosed

Your ophthalmologist will be able to diagnose shingles in the eye just by looking at the rash on your eyelids and surrounding areas. They might take a sample of the blister fluid to examine for the varicella-zoster virus.

They will also examine your cornea, retina, lens and other parts of your eye, looking for swelling and damage that may have been caused as a result of the virus.

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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.

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.

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Shingles Of The Mouth

Shingles can affect the mouth if the virus affects certain parts of the trigeminal nerve.

Shingles in the mouth may present as small, fluid-filled blisters on the palate and gums. It can also affect the tongue. Oral presentations of shingles may or may not occur in addition to a skin rash or lesions on the face.

Complications of shingles of the mouth may affect the teeth, and include tooth loss and tissue decay.

Shingles Symptoms: The Rash

The rash associated with herpes zoster begins as small blisters in a reddish background. New blisters form for the next few days, usually 3 to 5 days. Blisters emerge in a path of individual nerves in a specific ray-like distribution called a dermatomal pattern. Blisters tend to break out in a band-like pattern over an area of skin.

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If I Have Disseminated Zoster/shingles What Can I Expect For My Hospital Stay

It is important to note that most people with shingles do not need to be in a hospital, but if you do:

• You will be in an airborne-contact isolation room.
• The door will be kept closed.
• A sign on your door will remind people who have never had chickenpox or the vaccine not to enter.
• The sign will also remind staff to wear gowns and gloves when entering the room.

Do I Need To Stay Away From Children Pregnant Women People With Cancer Or Anyone With A Weak Immune System After I Get The Zostavax Vaccine

According to the CDC, it is 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 there is no documented case of a person getting chickenpox from someone who has received the Zostavax vaccine.

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When Should I See A Doctor

If you think you may have shingles, see your doctor as soon as possible. “Treatment is most effective when given within 72 hours of the appearance of rash and blisters,” advises Dr. Mohring. “Any rash accompanied by pain, including fever or headache, should prompt you to have a conversation with your doctor, especially if it’s a fluid-filled blister.”

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.

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Can Shingles Be Prevented

There are 2 vaccines available to reduce the likelihood of developing shingles, Zostavax and Shingrix. If you are over 50, you can talk to your doctor about whether you need it. It is recommended for everyone over 60 and is given free of charge in Australia to people aged 70 to 79.

Vaccination will not guarantee that you will not get shingles, but it will reduce your chance of developing the condition. The vaccine used to protect against shingles is not the same as the vaccine used to protect against chickenpox. Read more about the chickenpox vaccine here.

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.

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How Can I Help Prevent Shingles

The recombinant zoster vaccine vaccine is available to prevent shingles or make it less painful.

Experts recommend the vaccine for all adults 50 and older, even if youve had shingles before. Two doses of the RZV vaccine are recommended. You should get the second RZV dose 2 to 6 months after the first. The vaccine makes it less likely that you will develop shingles. If you do develop shingles, your symptoms will likely be milder than if you hadnt been vaccinated. RZV is also advised even if you had the older shingles vaccine in the past. Thats because the RZV vaccine works better and protects you from shingles longer.

Talk with your healthcare provider about the best time for you to get vaccinated, along with the benefits and side effects.