How does shingles affect the eyes?

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June 27, 2024

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How does shingles affect the eyes?

Shingles, also known as herpes zoster, can significantly affect the eyes if the varicella-zoster virus reactivates in the ophthalmic branch of the trigeminal nerve. This condition is called herpes zoster ophthalmicus (HZO). When shingles involves the eyes, it can lead to a range of complications, some of which can cause permanent vision damage if not treated promptly. Here’s an in-depth look at how shingles affects the eyes:

1. Herpes Zoster Ophthalmicus (HZO)

Description:

  • Involvement: HZO occurs when the varicella-zoster virus reactivates in the ophthalmic division of the trigeminal nerve, which supplies sensation to the forehead, upper eyelid, and front of the eye.
  • Symptoms: HZO typically presents with a painful, blistering rash on the forehead, upper eyelid, and around the eye. This rash may be accompanied by swelling and redness.

2. Symptoms of Eye Involvement

Early Symptoms:

  • Pain: Severe pain in and around the eye, which may precede the rash.
  • Redness and Swelling: Redness of the eye and swelling of the eyelids.
  • Tearing: Increased tearing or watery eyes.
  • Photophobia: Sensitivity to light.

Ocular Symptoms:

  • Blisters: Vesicular rash on the eyelids, forehead, and possibly the tip of the nose (Hutchinson’s sign), which indicates a higher risk of eye involvement.
  • Conjunctivitis: Inflammation of the conjunctiva (the membrane covering the white part of the eye).
  • Keratitis: Inflammation of the cornea, leading to corneal ulcers and scarring.
  • Uveitis: Inflammation of the uvea (the middle layer of the eye), causing eye pain, redness, and blurred vision.
  • Scleritis: Inflammation of the sclera (the white part of the eye), which can cause severe pain and redness.
  • Retinitis: Inflammation of the retina, which can affect vision.
  • Optic Neuritis: Inflammation of the optic nerve, leading to vision loss.

3. Complications

Keratitis:

  • Description: Inflammation and infection of the cornea.
  • Impact: Can lead to corneal ulcers, scarring, and vision impairment.
  • Symptoms: Pain, redness, blurred vision, and sensitivity to light.

Uveitis:

  • Description: Inflammation of the uvea, including the iris, ciliary body, and choroid.
  • Impact: Can cause severe eye pain, redness, light sensitivity, and blurred vision.
  • Symptoms: Pain, redness, photophobia, and decreased vision.

Glaucoma:

  • Description: Increased intraocular pressure due to uveitis or other inflammatory processes.
  • Impact: Can lead to optic nerve damage and vision loss.
  • Symptoms: Eye pain, headache, blurred vision, and halos around lights.

Retinal Necrosis:

  • Description: Severe, sight-threatening inflammation of the retina.
  • Impact: Can lead to retinal detachment and permanent vision loss.
  • Symptoms: Decreased vision, floaters, and flashes of light.

Optic Neuritis:

  • Description: Inflammation of the optic nerve.
  • Impact: Can cause temporary or permanent vision loss.
  • Symptoms: Pain with eye movement, vision loss, and color vision changes.

4. Diagnosis and Evaluation

Medical History and Physical Examination:

  • History: Detailed medical history including any previous episodes of chickenpox or shingles.
  • Examination: Thorough examination of the skin rash, particularly the distribution and characteristics of the blisters.

Ophthalmic Examination:

  • Visual Acuity Test: Measures the clarity of vision.
  • Slit-Lamp Examination: Allows detailed examination of the anterior structures of the eye.
  • Dilated Fundus Examination: Evaluates the retina and optic nerve.
  • Intraocular Pressure Measurement: Checks for increased eye pressure associated with glaucoma.

5. Treatment

Antiviral Medications:

  • Examples: Acyclovir, Valacyclovir, Famciclovir
  • Purpose: Early administration of antiviral medications (within 72 hours of rash onset) can reduce the severity and duration of symptoms and prevent complications.
  • Dosage: Follow the prescribed dosage and duration as directed by a healthcare provider.

Corticosteroids:

  • Purpose: To reduce inflammation and prevent complications such as uveitis and keratitis.
  • Forms: May be administered as oral tablets, eye drops, or injections, depending on the severity and location of inflammation.

Pain Management:

  • Over-the-Counter Pain Relievers: Acetaminophen or NSAIDs such as ibuprofen.
  • Prescription Medications: Stronger pain medications may be necessary for severe pain.

Topical Treatments:

  • Antibiotic Eye Drops or Ointments: To prevent secondary bacterial infections.
  • Cycloplegic Eye Drops: To relieve pain associated with uveitis by relaxing the ciliary muscle.

6. Prevention

Vaccination:

  • Shingles Vaccine (Shingrix): Recommended for adults aged 50 and older, and for those with weakened immune systems. The vaccine significantly reduces the risk of developing shingles and its complications.

7. Prognosis and Long-Term Management

Regular Follow-Up:

  • Eye Exams: Regular follow-up appointments with an ophthalmologist are crucial to monitor the condition and manage any complications.
  • Managing PHN: If PHN develops, long-term pain management strategies may be needed.

Conclusion

Shingles can have serious implications for eye health, particularly if it affects the ophthalmic branch of the trigeminal nerve. Complications such as keratitis, uveitis, glaucoma, retinal necrosis, and optic neuritis can lead to significant and potentially permanent vision loss if not treated promptly. Early diagnosis, prompt antiviral treatment, and regular ophthalmic evaluation are essential in managing shingles affecting the eyes. Vaccination with the shingles vaccine is a highly effective preventive measure to reduce the risk of developing shingles and its associated complications. If you experience symptoms of shingles near or involving the eyes, seek immediate medical attention to prevent serious outcomes.

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