A stroll through Gardens of the World on Thousand Oaks Boulevard with a visiting parent or grandparent is a lovely way to spend a holiday afternoon. It is also the kind of time when families notice that an older relative seems unwell: a headache that will not quit, a tingling or burning on one side of the forehead, and then a rash. When shingles appears around the eye, it needs prompt medical attention.
What herpes zoster ophthalmicus is
Shingles is caused by the same virus as chickenpox, which stays dormant in the body and can reactivate years later. EyeWiki, the American Academy of Ophthalmology’s clinical encyclopedia, describes herpes zoster ophthalmicus (HZO) as shingles affecting the branch of the facial nerve that supplies the forehead, eyelid and eye. EyeWiki notes that about 90% of people have been exposed to the virus.
Early symptoms
EyeWiki says many cases start with fever, tiredness, headache and eye pain before the rash appears. The rash is usually on one side of the forehead and scalp, sometimes the eyelid. Patients may notice eye redness, tearing, eye pressure or blurry vision. Pain can be severe.
A warning sign on the nose
Blisters on the tip, side or root of the nose, called Hutchinson’s sign, are a strong predictor that the eye itself will be involved. That is a reason for an eye exam the same day or the next.
Why prompt care matters
Doctors usually treat shingles with antiviral medicine by mouth, ideally started as early as possible. Shingles involving the eye can cause inflammation of the cornea and inside the eye, and high eye pressure. An ophthalmologist checks for these problems and may add eye drops. Even if the rash is the only sign at first, follow-up visits matter, because eye problems can develop later.
The vaccine conversation
EyeWiki notes that shingles vaccination is recommended for adults over 50, and for adults 18 and older who are or will be at higher risk because of a weakened immune system. In the clinical trials that led to approval of the recombinant shingles vaccine in the U.S., it was more than 90% effective at preventing shingles. If you or your parents have not had it, ask your primary care doctor or pharmacist whether it is right for you.
Contact lens wearers with any red, painful eye should take lenses out and get seen; this contact lens safety blog explains common warning signs.
A rash near the eye is not something to treat at home with cream and patience. Call your doctor, and ask about the eye.
Source: Herpes Zoster Ophthalmicus (EyeWiki, American Academy of Ophthalmology). This article is an educational summary written by Khanna Vision Institute and is not a substitute for medical advice.