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.
Shingles In The Eye: Symptoms And Treatment
If youve ever had the chickenpox, there is a chance you may develop shingles. Shingles is a painful rash caused by the reactivation of the chickenpox virus. This rash will break out across one side of the body with a burning or tingling sensation. It may also cause flu-like symptoms. There are more 200,000 cases in the United States each year. If you develop shingles, it is possible for the rash to appear on your face, and can even get into your eyes.
If shingles develops on your face, pay close attention to your eyes. Shingles in the eyes can create serious vision problems. The ocular surface can become swollen and inflamed, causing pain and blurry vision. Corneal ulcers can also develop and may lead to permanent scarring. The virus may even damage the corneal nerves causing chronic problems with ocular healing.
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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Treatments For Shingles In The Eye
There are a variety of different treatments for shingles in the eye. If your optician diagnoses eye involvement, you may also need topical eye drops. There are two main types of topical eye drops for shingles:
Corticosteroid eye drops Steroid drops can reduce the eye inflammation caused by shingles, Rapuano says. This lowers the chances of complications from shingles of the eye.
Pupil-dilating eye drops Your optician also may prescribe eye drops to keep the pupils open for pain relief due to an internal ocular inflammation caused by shingles.
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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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
Who’s At Risk For Shingles
Anyone who has ever had chickenpox can get shingles, but the risk increases with age. People older than age 60 are up to 10 times more likely to get shingles than younger people. Other factors that increase your risk include:
- Some cancer medicines
- A weak immune system from illnesses such as cancer or HIV
A quarter of adults will develop shingles at some point, and most are otherwise healthy.
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Signs Of Shingles In The Eye
Shingles in the eye is called herpes zoster ophthalmicus. Symptoms of this condition include:
- Redness and swelling around the eyelids
- Irritated and itchy eyes
- Blistering on the upper eyelid, typically on one side of the face
- Light sensitivity
These are all signs that you may have shingles in your eye however, they can also be representative of other eye conditions. Whether you have shingles or not, you should see an ophthalmologist immediately.
Who Should Not Get The Vaccine
Do not get the shingles vaccine if:
- You have a severe allergic reaction, such as anaphylaxis, to any ingredient of a vaccine or to a previous dose of Shingrix
- You have shingles now.
You are sick with an illness and a fever of 101Â°F or higher.
- You should also consider delaying the vaccine if you are pregnant or breastfeeding. Not enough is known about its safety for expectant and lactating women.
- You have had a negative test for varicella this would be uncommon for adults eligible for the vaccine, as most adults worldwide ages 50 and older have been exposed to the virus. You do not have to be tested before getting the vaccine.
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What Is The Cornea
The cornea is the outermost layer of the eye and is the clear tissue that covers the colored iris and pupil. Its role is to focus light through its high powered refractive surface and protect the inner-workings of the eye. It contains no blood to protect it against infection. If it is injured or affected by disease, it may become swollen or scarred, and its smoothness and clarity may be lost. Scars, swelling or an irregular shape can cause the cornea to scatter or distort light, resulting in glare, blurry vision, or even pain.
What Are The Risk Factors
Youre more likely to have shingles if you had chickenpox as a child. While you can have shingles symptoms in teenage and young adult years, you are more likely to experience them as an adult over age 50.
If you have a compromised immune system due to factors like age, cancer treatment such as chemotherapy, HIV, or an autoimmune disease, you have a higher chance of getting shingles, including around the eye. Other medications can also weaken your immune system, including corticosteroids and tumor necrosis factor drugs.
As evidenced by the increase in cases from 2004 to 2016, stress can increase your chances of getting shingles. Pregnant women and premature infants also have a higher risk.
Shingles in your eye can result in long-term damage to your eye and surrounding areas. That damage can include:
- Postherpetic neuralgia
- Injury to the cornea
- Temporary or permanent vision loss
If you have existing eye conditions like glaucoma, that does not necessarily mean you are more likely to experience the rash in or around that same area.
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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.
Shingles In The Eye: Causes Symptoms Prevention & Treatments
If youve had the chickenpox virus as a child, you could develop shingles later in life. Shingles can appear anywhere on your body and cause complications, including in your eyes.
Shingles in eye areas can affect vision, along with the other painful and potentially dangerous symptoms that come with the virus. If you have symptoms of shingles, talk to your doctor for treatment options.
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Urgent Advice: Get Advice From 111 As Soon As You Suspect Shingles
You might need medicine to help speed up your recovery and avoid longer-lasting problems.
This works best if taken within 3 days of your symptoms starting.
111 will tell you what to do. They can arrange a phone call from a nurse or doctor if you need one.
Go to 111.nhs.uk or .
Get an urgent GP appointment
A GP may be able to treat you.
Ask your GP surgery for an urgent appointment.
How Long Does Shingles In The Eye Last
According to the National Institute on Aging, shingles generally takes 3â5 weeks to clear.
However, recovery may leave a few minor scars behind. Additionally, untreated shingles in the eye could cause lasting damage. Complications that result from this condition could also have a lasting impact.
Contact your doctor promptly for any new symptoms or if your symptoms do not improve with treatment.
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How Do Dermatologists Treat Shingles
An antiviral medication can:
Reduce the amount of time that you have a shingles rash
Lower your risk of developing long-lasting nerve pain and other health problems
One of three antiviral medications is usually prescribedacyclovir, famciclovir, or valacyclovir.
To treat your symptoms, dermatologists typically recommend the following:
Pain: Medication that you can buy without a prescription can help, such as:
If you have severe pain, your dermatologist may prescribe a medication that reduces inflammation, such as a corticosteroid.
Shingles In Eyes Causes Signs And Treatment
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Shingles is a painful medical condition that is related to the multiplication and growth of the varicella zoster virus in the nerves of the patient . The Shingles virus is one that a patient already has in them if the patient ever suffered from Chicken Pox as a child. The same virus that causes Chickenpox is the same one that causes Shingles. The illness called Shingles can also be known as herpes zoster or simply as zoster.
Shingles being a viral disease can exhibit many signs and symptoms. The virus affects any part of the body without prejudice but is more commonly found on the body torso or trunk, the neck, the face, ears and eyes. The main distinguishing marking of this disease is the rash or blisters that form along one half of the body in a banded or clustered pattern. This characteristic and unique identifying feature of the disease makes it easy to distinguish from other maladies.
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What Are The Symptoms Of Shingles In The Eye
When it comes to eye shingles, there is a difference between shingles appearing in the eye versus around the eye. When you have shingles in your eye, you may see them on your sclera .
Shingles in your eye present a higher risk, as it can cause vision problems, including sight loss, even after healing. When the rash appears around your eye, but not in it, doctors refer to it as eye involvement.
Regardless of where it appears, symptoms of shingles typically occur only on one side of the body. That means that even if you have a painful rash in or around one eye, the virus will probably not spread to the other side of your face.
Eye shingles can cause the following symptoms:
- Facial tingling
- Red blisters or a rash on the face
- Eyelid swelling and redness
- Sensitivity to light
You may also experience more generalized shingles symptoms too, including headache, low-grade fever, fatigue, and flu-like symptoms. Shingles typically start as nerve pain, and you will notice the red rash later on the painful areas.
If you initially get shingles elsewhere on your body, they can spread to your face, even after you begin recovering.
How Do You Treat Shingles In The Eye
Shingles respond well to antiviral medication, such as acyclovir, famciclovir, and valacyclovir. These medications stop the virus from spreading, help the rash clear more quickly, heal shingles blisters, and control nerve pain from the rash.
For the best results, start the antiviral medication within three days after you notice your symptoms. When treated early, most people recover fully from shingles. During this time, you can also take over-the-counter painkillers like acetaminophen or non-steroidal anti-inflammatory drugs .
If the rash spreads to your eye, your doctor may give you additional shingles treatments. They may prescribe a steroid medication in the form of eye drops or pills. Treating shingles in your eye requires more careful treatment, as it can cause more severe problems that affect your daily life if neglected.
If you develop postherpetic neuralgia, pain medications or antidepressants prescribed by your doctor can help.
When it comes to home remedies, you may find that a cool bath or shower can help soothe the nerve pain associated with shingles. Additionally, although not everyone experiences itching with shingles the way they do with chickenpox, calamine lotion can help those who do.
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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.
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.
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Keratoconus In The Early Stages
In the early stages, the patient will notice some slight distortion and sensitivity to light. Often these symptoms will show up in the teens through the early twenties. Even though keratoconus tends to progress slowly, it is a lifetime disease. As it gets worse, the most common complaints are increased astigmatism and/or near-sightedness, blurred vision, and frequent eyeglass prescription changes. Early stage patients with it can sometimes wear glasses, but as the condition progresses most patients need to wear specialized contact lenses in order to see their best. At The Eye Associates, our doctors are skilled at fitting the latest in contact lens treatments for this condition. Some of the options include rigid gas permeable contact lenses, piggybacking contact lenses, hybrid contact lenses, as well as scleral and semi-scleral contact lenses.
The Eye Associates that specialize in contact lens fittings for keratoconus patients. When good vision is no longer possible with contact lenses, a corneal transplant may be recommended. With this procedure, the surgeon removes the diseased portion of the cornea and replaces it with healthy donor tissue. He performs a revolutionary partial thickness transplant for keratoconus called Deep Anterior Lamellar Keratoplasty .
Shingles Of The Eye: Complications Symptoms And Treatment
Medically reviewed by Tina Patel on 6th September 2022
Shingles of the eye are also known as ophthalmic herpes zoster or herpes zoster ophthalmicus. It is a viral infection which causes a painful, blistering rash to appear in or around the eye. Shingles commonly affect the body more than the eyes and are caused by the varicella-zoster virus, which is the same virus responsible for chickenpox.
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