Shingles of the Eye a Serious Problem
Shingles is cutaneous infection caused by the Herpes zoster virus. You may recall that I discussed Herpes simplex infections in a previous column. Well, zoster is a very close relative of simplex and is the same virus that causes chicken pox. After many years of dormancy, zoster can reactivate, leading to a skin rash characterized by small, fluid filled blisters (called vesicles) which scab over and may lead to permanent scarring. Interestingly, these blisters do contain live virus and can infect susceptible individuals with the chicken pox virus. Although reactivation usually occurs in older people, young people and individuals with impaired immunity may also be affected.
The initial symptoms of shingles usually include severe pain or itching, followed by redness of the skin. Finally, the characteristic rash appears. The pain may precede the rash by one to two weeks. The blisters are usually very restricted in their distribution, since the infection reactivates along the route of the affected nerve.
Commonly, the pain is very intense, often accompanied by burning, throbbing and extreme skin sensitivity. Although the rash usually disappears after several weeks, many patients will experience persistent pain for months or years later. This persistent discomfort is called "post-herpetic neuralgia." It is a result of damaged sensory nerves which may take a very long time to heal.
Unfortunately, Herpes zoster frequently involves the nerves around the eye, especially the first division of the trigeminal nerve, which supplies the upper eyelid and forehead. If the infection involves the nerves that go directly to the eyeball, it can lead to serious eye problems, including intense intraocular inflammation and glaucoma. The ocular problems may occur immediately or may be delayed for several months after the initial appearance of the rash.
The treatment for zoster mainly involves pain control along with antiviral medications. Sometimes oral steroids are given to help reduce the nerve damage that leads to the post-herpetic neuralgia. The ophthalmologist usually treats any ocular involvement with the aid of eyedrops, eye ointments or oral medications. Although most people recover without complications, some are left with chronic pain and discomfort and/or loss of vision.
