The virus that causes the well-known childhood illness chickenpox and its more adult counterpart shingles can reactivate in a number of ways throughout one’s life. If it does so in a site that involves the area around or in the eye, it is known as herpes zoster ophthalmicus. The condition is often very painful and can cause significant complications if left untreated. It is important to understand what causes the condition as well as what signs and symptoms to look out for.
What Is Herpes Zoster Ophthalmicus?
More commonly known as “shingles,” herpes zoster is the viral disease that presents as a painful skin rash made of small fluid-filled blisters that scab and can leave permanent scars. If it involves the region in or around the eye, it is known as herpes zoster ophthalmicus and can cause significant eye issues, including corneal ulcers, chronic inflammation, and glaucoma.
All parts of the eye are susceptible to the herpes viruses and may be affected by the condition. The cornea is most commonly affected by HSV and HZV. When inflammation reaches the cornea, it is known as herpetic keratitis. The viruses can also cause rash and infection in the eyelids, uveal tissue, and retina. Because of the significant risk of complications, it is important to contact your doctor if you notice any symptoms you think may be related to herpes zoster ophthalmicus.
Symptoms of Herpes Zoster Ophthalmicus
The telltale sign of shingles of the eye is the painful skin rash that generally accompanies this viral disease. In any of its forms, the condition is usually recognizable by the small, fluid-filled blisters that form and scab on the skin. However, there are several other symptoms that may occur in addition to the rash in the case of herpes zoster ophthalmicus.
Common symptoms of the condition include:
- Blisters located on and around the upper eyelid and forehead on one side of the face;
- Tingling, burning, itching, and/or throbbing located around the eye;
- Redness or rash that affects the skin around the eye;
- Extreme skin sensitivity to touch;
- Redness, irritation, and tearing of the eye;
- Eyesight changes, including blurred vision.
Experiencing one of the above symptoms does not necessarily guarantee that you have herpes zoster. But it is important to contact your ophthalmologist for a complete exam if you do find yourself dealing with one or more of these symptoms.
Causes of Shingles of the Eye
The same virus that causes chicken pox, varicella zoster, is responsible for herpes zoster ophthalmicus as well. The varicella virus remains in the body after you have contracted it. Itt can resurface years later in the form of shingles, which includes skin pain and rash. Concurrent eye problems may develop at the same time as the skin rash. Alternatively, they can manifest weeks after the lesions have even disappeared.
Individuals who have never contracted the virus itself or never had chicken pox cannot get shingles in any form. The vaccine for herpes zoster can be administered to reduce your risk of developing the condition, but it’s never a sure thing.
Is Ocular Herpes Contagious?
Even in the eyes, herpes can be contagious. The live virus is often transferred in the tears of individuals infected with active corneal herpes and/or herpes zoster as well as from active rashes or site outbreaks. As such, it is extremely important to maintain proper handwashing procedures. This is important if you will be in contact with babies, children, or individuals who are immunocompromised.
How Is Herpes Zoster Ophthalmicus Transmitted?
Typically, the condition is not transmitted directly from one eye to the other. Rather, the virus is contracted by a direct encounter with the virus and results in no initial signs or symptoms. Following this initial encounter, the virus settles into your body and falls into its dormant or latent stage. Months or years down the road, the virus may reactivate and move into the eye where it causes the ocular condition.
In small children, a small rash or pinkeye may be a first indicator of the condition. In many cases, the zoster vaccine is acquired through the air during an outbreak of chickenpox. It may remain dormant for decades prior to reactivating and causing shingles in the eye or elsewhere.
Who Is At Risk?
While nearly 85 percent of the population carries the virus for the condition, not everyone who is a carrier will get an eye infection. The virus is most likely to cause an infection with the carrier becomes immunocompromised for some reason. For example, an individual might become susceptible if he or she is on medication such as steroids or chemotherapy, is under a lot of stress, or contracts a condition like HIV. If that is the case, the virus may become active and cause an outbreak of the infection.
Herpes Zoster Ophthalmicus Treatment
Because the condition is caused by a virus, antibiotics, including penicillin, are not an effective option for treatment. The only medications that will remedy the condition are antiviral drugs.
If you contract the condition, your doctor will likely prescribe antiviral pills to speed your healing process and reduce the effects of the condition. It is important to you continue taking the medication for as long as your doctor prescribes even if your eye begins to look and/or feel better. If you stop taking the medicine too soon, you could relapse.
If the infection is also affecting you cornea, your doctor may also recommend corticosteroids eye drops. These drops will help control the disease, but the treatment may also cause the pressure in your eyes to increase. If you are using a corticosteroid, it is important to you return to your doctor for your scheduled follow up to check the pressure levels in your eyes.
Unfortunately, you may continue to experience pain even several days after starting treatment. While this can be disappointing, it does not mean that your treatment has filed. Continue taking the medication as prescribed, and the pain will go away.
Herpes zoster is a relatively common condition caused by the same virus as chickenpox. If spread to the eyes, it is known as herpes zoster ophthalmicus. If you notice symptoms of the condition, such as redness or irritation in your eyes or the telltale rash, it is important that you see your doctor as soon as possible for treatment. Most patients undergo a round of antiviral medication in combination with a corticosteroid if necessary. The condition can be painful, but if it is treated correctly, it will go away eventually.