What is Herpes Zoster or Commonly Known as Shingles?
Herpes Zoster is the reactivation of the virus that causes the common childhood disease called chicken pox. The virus stays dormant in the nerves after a chicken pox infection. The virus reactivates itself possibly in response to stress, illness or cancer (decreased body defenses), certain medications, and for no known reason. Herpes Zoster can occur at anytime but is more common after age 55.
General Symptoms of Herpes Zoster
Herpes Zoster usually begins with pain which is closely followed by a skin rash and blisters in the area of pain. The rash and blisters occur on one side of the body following the path of a branch of a nerve. They break out anywhere but the area concerned with the eye will be discussed. The pain can be severe in many cases and may last for a long period of time even after the rash has healed. It can also be accompanied by fever and general feeling of being ill. A person may contract chicken pox from someone with herpes zoster if they have never had chicken pox but a person will not get herpes zoster from someone with chicken pox.
Ocular Symptoms of Herpes Zoster
There are three divisions of the 5th cranial nerve which supply sensation to the face and area around and in the eye. The forehead and upper lid with sometimes a small branch to the tip of the nose is the first division. The cheek area is the second division of the 5th cranial nerve. The jaw area is the third division of the 5th cranial nerve. The first division of the 5th cranial is the most common location on the face. Ocular symptoms and severity of the infection vary from person to person. The eyelids are commonly affected with severe scarring occurring in some individuals. Red eyes and conjunctivitis are also common. The cornea of the eye can become infected with lesions on the cornea which can be difficult to treat with reoccurrences in some people. The inside of the eye can become involved causing glaucoma, cataracts, muscle weakness, inflammation of the retina and optic nerve which can lead to significant vision loss.
Treatment of Herpes Zoster
Ocular treatment is usually an antibiotic-cortisone drop and/or ointment applied to the lids and in the eye. Any of the more severe complications would be treated as necessary. Sometimes an antiviral ocular medication may be used in the eye.
Systemic antiviral medication will be started. In many cases a short duration of high dose cortisone will be added.