Herpes Zoster (Shingles) Eye Infections

What is herpes zoster?

Herpes zoster, also called shingles, is a disease caused by the varicella-zoster virus. This is the virus that causes chickenpox. Sometimes, many years after you have had chickenpox, the varicella-zoster virus becomes active again and causes shingles.

Shingles causes painful blisters on the skin, often along major nerves. It may affect the eyes. Sometimes you can have nerve pain that lasts for a long time after the blisters go away.

What are herpes zoster eye infections?

If the varicella-zoster virus is affecting the nerves in your forehead, nose, or eyelids, your eye may be affected. The virus can cause several problems, including:

• blisters on or inside your eyelids
• damage to your cornea (the clear outer layer on the front of the eye)
• scleritis (swelling of the white part of the eye)
• uveitis (swelling of the iris or the back part of the eye)
• glaucoma (increased pressure inside the eye)
• cataracts
• retinitis (inflammation of the retina in the back of the eye)

How do they occur?

The first time you are exposed to the varicella-zoster virus, you usually develop chickenpox. After you recover, the virus stays in your body. Usually your body's immune system is strong enough to keep the virus from causing any problems. However, the virus can become active if your body's immune system becomes weakened by:

• aging
• diseases such as AIDS or Hodgkin's disease
• physical or emotional stress
• fatigue
• poor nutrition
• chemotherapy or radiation, including sun exposure
• certain medicines, such as steroids

Sometimes problems from herpes zoster occur for no known reason.

What are the symptoms?

Symptoms of herpes zoster eye infections include:

• blisters on the forehead, eyelids, or the nose with redness around the blisters
• swollen eyelids
• eye pain
• watery eyes
• red eyes
• sensitivity to light
• blurred vision

How is it diagnosed?

Your healthcare provider will ask about your medical history and symptoms. Your provider will also examine your skin and eyes. The blisters usually occur in a certain pattern near affected nerves. If necessary, fluid from the blisters can be tested in a lab to see if the virus is present.

How is it treated?

Several medicines are helpful in treating herpes zoster eye infections.

• Antiviral medicine, such as acyclovir, can speed your recovery and help reduce complications. This medicine is most effective when started as soon as the first symptoms appear.
• Steroids can sometimes be used to reduce eye inflammation.
• Antibiotics prevent infection from other organisms that may get in your eyes while you have herpes zoster.
• Painkillers (such as acetaminophen) and lubricating eyedrops may lessen your pain.
• Medicines for glaucoma help keep the pressure in your eye at normal levels.

How long will the effects last?

The blisters will heal in 1 to 3 weeks and the pain or irritation will usually go away in 3 to 5 weeks. You may develop permanent scars and long-standing pain (called neuralgia), numbness, or discolored skin. If your cornea is affected, it can become permanently scarred. Early treatment with acyclovir may lessen the effects of the varicella-zoster virus and can sometimes prevent serious complications.

Numbness of the cornea and inflammation inside the eye can sometimes cause long-term eye problems that require careful follow up.

Are herpes zoster eye infections contagious?

A person with shingles can transmit chickenpox to a person who has never been exposed to the varicella-zoster virus. The virus is spread by contact with the blisters. You are no longer contagious after the blisters dry up and form scabs.

What can I do to help prevent herpes zoster eye infections?

All children now get shots to prevent infection with the chickenpox virus. If you have never had chickenpox, you can get a shot to help prevent infection with the virus. A vaccine, called Zostavax, is now available for people 60 years of age and older. The vaccine can help prevent or lessen the symptoms of shingles. It cannot be used to treat shingles once you have it.

If you have not been vaccinated and have never had chickenpox, you should avoid contact with people who may have an active chickenpox infection. If you are pregnant, you should not be around someone with chickenpox or shingles.

Sometimes attacks of shingles occur for no apparent reason and cannot be prevented. Early diagnosis and treatment can help greatly in reducing serious complications from herpes zoster eye infections.

Reviewed for medical accuracy by faculty at the Wilmer Eye Institute at Johns Hopkins. Web site: http://www.hopkinsmedicine.org/wilmer/

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