What to Know About Shingles in the Eye

Shingles, caused by the varicella-zoster virus associated with chickenpox, affects the eye in about 10% to 20% of cases. Eye shingles is called herpes zoster ophthalmicus or ophthalmic zoster. If it's not treated promptly, eye shingles can lead to complications like scarring, vision loss, and other long-term problems.

Getting a shingles vaccine can help you avoid this condition. This article will present everything you need to know about eye shingles, including how it arises, symptoms, treatment, and the outlook for those with this condition.

How Can Shingles Get Into the Eyes

The varicella-zoster virus is responsible for shingles anywhere in the body. The initial infection produces chickenpox. The virus can be dormant in nerve cells for a long time after you've recovered from chickenpox.

Ophthalmic Zoster

In ophthalmic zoster, the virus remains dormant in nerve cells for years. If it awakens, it can travel along the trigeminal nerve. This is one of the cranial nerves tasked with bringing sensations to the face. Its first branch is the ophthalmic nerve, which runs to the eye. The virus can move to the surface and erupt in painful lesions.

Symptoms of Shingles

Shingles may start with vague symptoms such as a headache, malaise (generally not feeling well), and a fever. You may also feel an itching or burning sensation, or numbness in the area involved. It may take a couple of days before you develop the quintessential shingles blistery rash on one side of your body—the one involving the affected nerve.

Over the next few days, these itchy blisters, which resemble chickenpox, may begin to appear yellowish and start to dry out. They may ultimately scab over, which may then cause some scarring. Shingles can make you pretty miserable. When it's in the eye, it can have severe ramifications.

Symptoms of Shingles in the Eye

The first signs of herpes zoster ophthalmicus usually start in the scalp, cheeks, or forehead, where you may feel a burning, pricking, or tingling sensation. A few days later, a painful rash may erupt where the uncomfortable sensation was, including around the eye.

In particular, if the rash is on the tip or side of the nose, the eye usually is affected.

The eye itself may have the following symptoms:

• Redness
• Sensitivity to light
• Feeling like there's something in your eye
• Pain
• Blurriness or a reduction in vision
• Discharge akin to what you might see with pink eye (conjunctivitis)

How Shingles in the Eye Is Diagnosed

You may go to a healthcare provider when you develop symptoms. They may refer you to an eye doctor if they suspect eye shingles.

To determine if you have ocular shingles, the eye specialist will look closely at the rash on the scalp, forehead, or around the eye. They will also examine the eye using a slit lamp, with which they will shine a bright light on the eye to view the structures, including the back of the eye, and detect any issues.

If there is a rash, they may be able to tell that this is ophthalmic shingles by the distinctive appearance alone. But in some cases, no rash will occur.

If your eye doctor suspects ophthalmic shingles, your tear film (the liquid on the surface of your eye) may be tested with a polymerase chain reaction (PCR) for signs of the varicella-zoster virus. But this test is expensive and not widely available.

How Shingles in the Eye Is Treated

While there is no cure for eye shingles, antiviral treatment can help manage it. The sooner it is started, the better.

Seven days of treatment with antiviral medication, such as oral acyclovir, valacyclovir, or famciclovir, can reduce the possibility of eye complications by 20% to 30% and decrease the length of time you need to deal with pain by 50%.

Topical steroids may be given for some eye complications, such as uveitis (inflammation in the center of the eye) or interstitial keratitis (inflammation of the cornea, the clear dome at the front of the eye).

Oral or intravenous (IV) steroids may be given if it affects the white of the eye (sclera), the light-sensing retina at the back of the eye, or the optic nerve. Pain may be managed with systemic medications or topical cream.

Complications of Shingles in the Eye

It's best to detect ocular shingles early and try to control it with treatment. Even so, you may run the risk of a variety of complications, which in some cases may be sight-threatening, such as the following:

• Inflammation and scarring of the cornea
• Development of an open sore on the cornea
• Abnormal new blood vessels growing in the cornea
• Inflammation of the colored part of the eye (iritis) or inside the eye (uveitis)
• Swelling of the light-sensitive retina at the back of the eye
• Lingering nerve and skin pain persisting after the shingles rash clears known as postherpetic neuralgia. This may continue for years afterward and is an issue for 10% to 18% of people with shingles.
• Risk of vision reduction or blindness

With your vision possibly at risk, it's important to take eye shingles seriously and contact a healthcare provider or eye specialist right away, as you would with any health emergency.

Risk Factors of Shingles

While shingles can affect anyone who has had chickenpox before, certain factors can put you at greater risk of developing this condition, including:

• Being over age 50 (likely due to the weakening of the immune system with age)
• Having human immunodeficiency virus (HIV), which affects the immune system
• A cancer diagnosis, such as lymphoma or leukemia
• Receiving cancer treatments such as chemotherapy
• A weakened immune system due to medications for an organ transplant or an autoimmune disease such as psoriatic arthritis

Outlook for People With Shingles in the Eye

How you fare with ophthalmic zoster will depend on any complications you face. Certain complications, such as inflammation in the eye, can cause permanent vision loss. Likewise, corneal scars can affect vision and may require you to wear a hard contact lens or undergo a corneal transplant in some cases.

How to Prevent Shingles

To keep shingles at bay in the first place, the Centers for Disease Control and Prevention (CDC) recommends a recombinant zoster vaccine (RZV) named Shingrix. This can allow you to avoid any related complications, including those affecting vision.

Shingrix is recommended for adults age 50 and over. People age 19 and over who have a weakened immune system may also receive the vaccine after consultation with a healthcare provider.

Is Shingles Contagious?

If you have shingles, others who have not previously had chickenpox or received the chickenpox vaccine can be affected. The virus can be transmitted by direct contact with the fluid in the blistery rash or inhalation of the virus particles from the rash.

If they acquire the virus, they will develop chickenpox rather than shingles. Chickenpox is much more transmissible. Having chickenpox leaves the person vulnerable to later developing shingles.

When to See a Healthcare Provider

Contact a healthcare provider at the first sign of shingles.

If you get inflammation inside the eye as a complication of shingles of the eye, keep in mind that there's a risk that this may return well after the medication has stopped and you assume the condition has resolved.

Even if it's years later, if you develop a sore, red eye again, it's important to immediately contact a healthcare provider or eye doctor to see whether the condition has flared up again.

Summary

Shingles can occur in anyone who has previously had chickenpox. The virus can stay dormant in the nervous system for decades and may awaken when the immune system is weakened. In some cases involving the trigeminal nerve, the eye may be affected, and your vision is potentially at risk.

While there is no cure for eye shingles, antiviral treatment can help to manage it. Still, complications threatening your vision can occur and lead to permanent vision loss in some cases. The Shingrix vaccine is recommended to prevent shingles and its complications.