Hello and welcome to Case of the Day! I’m Dr. Croley and today we’re gonna discuss an eye disease where recently we had two patients come in with this problem. Since it’s not a typical thing that happens, so we thought we’d go over that.
We’ve had two patients in the last two weeks who come in with herpes zoster or shingles, commonly known as shingles, along their forehead and face on one side and they both have had actually the zoster vaccine. Now this is about the fourth or fifth person who’ve actually seen in my office who’s had actually the vaccine to prevent the zoster from happening who actually still got it. So I thought we would cover a little bit about that and go over that today.
Herpes zoster or shingles is caused by the same virus that causes chicken pox. Before you can get shingles, you have to have had chicken pox in your lifetime. Once you’ve had chicken pox, that virus lives in the nerve cells of your nervous system for the rest of your life. And through a variety of things, you’ve become ill, or you’ve become weakened, or even during the holidays, or sad times, things that just typically throw your immune system off can let this shingles pop out and then you get this rash and it follows the pathway of a nerve. And so it comes around the side of someone’s trunk or chest. And in the case of the face, it will follow the tract of the fifth cranial nerve which supplies sensation to the face. So typically more often, it does the forehead, sometimes on eyelids which is the first division of the fifth cranial nerves. Case I’ve seen are on the cheeks and very rarely down on the jaw area which is a different division on the fifth cranial nerve. It’s typical rash or this little vesicle pops up and then opens up then you get this sort of scaly rash that happens. It loses for a while then slowly dries up.
Interesting as far as the eye goes, it affects the lids and the forehead and can get on the eyelid and the brow area. But if you get a spot along your nose then that means there’s a very good chance that you’ll gonna get it in the eye itself. So that is a significant sign if you get a lesion on your nose as well as your forehead. The treatment, if we put people on systemic antiviral medication, sometimes prednisone then I also typically will put people on some cortisone and antivirals in their eye, just as a preventative thing. That’s the usual treatment.
The case of these two ladies recently in the last couple of weeks, they actually have had the vaccine. The vaccine is recommended for people over age 65 because there’s a higher incidence as we get older. Their immune system weakens and then it pops out or more likely to happen. Unfortunately the vaccine is not a guarantee. There are people who still get a shingles episode after the vaccine. The vaccine certainly I think is a very strong evidence that it decreases your risk of getting it but it does not a hundred percent stop you from getting it. And at least so far, the cases that I have seen are of the less severe type of the ones I’ve seen. So maybe it’s also allowing you to have a milder case of the shingles for having the vaccine.
So if you’re over 65 and considering getting a vaccine, I would highly recommend you talk with your medical doctor about what they recommend and you certainly can get the vaccine in their office.
So if you have any questions about shingles or herpes zoster, we’d be happy to answer those through the website. If not, may God grant you healthy eyes and great vision.