What is Herpes Zoster Ophthalmicus?
Herpes zoster infection, often known as shingles, is a common viral infection that occurs when the chickenpox virus (varicella-zoster) reactivates later in life.
When the herpes zoster infection affects a nerve in the face called the ophthalmic nerve, it is called herpes zoster ophthalmicus, or ophthalmic shingles.
There are around 1 million cases of shingles each year in the United States,[1] up to 25 percent of which are herpes zoster ophthalmicus.[2]
People who have previously had chickenpox are at risk of developing herpes zoster ophthalmicus. It most commonly affects older people and people with a weakened immune system.
The typical symptoms of ophthalmic shingles are:
- Painful, blistering rash over the face and eye- Eye pain and redness on the same side as the rash.
If you are concerned that you may have this condition, please check with your doctor Find my Doctor to find out more about your symptoms.
Ophthalmic shingles is typically treated using antiviral medications, which may need to be given through a drip (intravenously) if symptoms are severe.
If not treated adequately and quickly, herpes zoster ophthalmicus can cause permanent vision problems, such as:
It is important to see a doctor without delay if the symptoms of herpes zoster ophthalmicus appear.
Symptoms of herpes zoster ophthalmicus
Ophthalmic shingles often begin with a tingling, burning pain over the eye, forehead, temple, and nose. This is followed up to a week later by a blistering rash:[3][4]
- The rash is vesicular; vesicles are small, blister-like sacs that appear on the surface of the skin
- The skin around the vesicular rash becomes red
- The rash is generally confined to one side of the face. In people with weakened immune systems, the rash may be more widespread
- The rash blisters burst and scab over, usually seven to 10 days after first appearing
- The rash generally goes away after two to four weeks
Good to know: People with this condition are contagious until the rash has scabbed over.
As well as the rash, people with herpes zoster ophthalmicus often develop:
- A painful, watering eye on the same side as the rash
- Swelling around the eye
- In some cases, ocular problems
Worried you may have herpes zoster ophthalmicus? You can Please check with your doctor Find my Doctor for a free assessment.
People with shingles may also experience:
- Headache
- Fever
- Chills
- Loss of appetite
Read more about Signs of Shingles »
Causes of herpes zoster ophthalmicus
Only those who have previously had chickenpox are at risk of developing shingles or ophthalmic shingles. Herpes zoster infection occurs years, sometimes decades, after a person has been infected with the varicella-zoster virus that causes chickenpox.
The virus remains dormant (inactive) in the nervous system and can reactivate if a person’s immunity to varicella-zoster weakens over time, either due to age or if another condition causes a person’s immune system to weaken. Stress and/or illness may trigger a reactivation of the virus.
In ophthalmic shingles, the virus reactivates in the trigeminal ganglion, a cluster of nerves located to the sides and base of the skull. The trigeminal ganglion is connected to the ophthalmic nerve. If the virus reactivates, it travels up the nerve to the skin and the eye, and this is how the infection affects the eye.[4]
People with weakened immune systems are more likely to develop herpes zoster ophthalmicus than the general population. A weakened immune system may be the result of various conditions, such as:
- Chemotherapy for cancer
- Leukemia
- HIV infection
- Immunosuppressive drugs taken before or after an organ transplant
- Long-term use of certain drugs, such as steroids
Good to know: People with any of the above-mentioned conditions or any other form of the weakened immune system should avoid contact with someone with an active case of shingles, herpes zoster ophthalmicus or chickenpox. Pregnant women and unvaccinated children or adults should also avoid people with an active case of shingles.
Diagnosis of herpes zoster ophthalmicus
A diagnosis can usually be made based on the symptoms and the appearance of the rash, as well as through an examination of the eye. If uncertain, the diagnosis can be confirmed with blood tests or by taking a sample of fluid from a blister and testing for the virus.
An ophthalmologist should examine the eye for signs of corneal disease and other eye problems.[5]
Treatment of herpes zoster ophthalmicus
Ophthalmic shingles should be treated urgently with oral antiviral medication, which helps to manage the pain and reduces the risk of complications occurring. Drugs often prescribed to treat ophthalmic shingles include:[6]
- Acyclovir
- Famciclovir
- Valacyclovir
People who have a weakened immune system or who develop severe vision problems may need to receive acyclovir intravenously (through a drip).
Eye drops containing corticosteroids may also be needed. They should be taken with care due to the potential of an increased risk of eye complications such as keratitis.[4]
Anti-inflammatory medications, such as ibuprofen, or other analgesics, may help reduce the pain and swelling.
People with shingles should try to avoid scratching at the rash. Calamine lotion and wet compresses can help soothe the itching. It is important to consult a medical practitioner before putting anything on or in the eye, and it is very important to avoid scratching the eye or the area around the eye, as bacterial infections may occur and lead to complications.
Complications of herpes zoster ophthalmicus
Possible complications of herpes zoster ophthalmicus include:[2][7][8]
- Conjunctivitis: Inflammation of the lining of the eye
- Keratitis: Inflammation of the cornea, which could lead to visual impairment
- Blepharitis: Inflammation of the eyelid
- Uveitis: Inflammation of the iris and ciliary body[9] in the eye
- Episcleritis: Inflammation of a clear layer over the white of the eye
- Scleritis: A serious condition in which the white of the eye becomes inflamed
- Retinal necrosis: This can produce pain and/or blurred vision, and can ultimately lead to blindness
People with weakened immune systems are more likely to develop ocular complications from ophthalmic shingles.
Postherpetic neuralgia
Some people with herpes zoster ophthalmicus will experience postherpetic neuralgia (PHN), which is pain that lasts after the rash and blisters disappear. Symptoms include:[2][4]
- Pain in the eye and area of the face affected by herpes zoster ophthalmicus. This may be constant or intermittent.
- Allodynia, which is when pain is triggered by non-painful stimuli, such as light touch or wind blowing on the face.
The number of people who will experience postherpetic neuralgia ranges from 10 to 30 percent.[4]
The experience of living with postherpetic neuralgia may affect a person’s mental health, for example it can increase the risk of clinical depression.
Prevention of herpes zoster ophthalmicus
People who have shingles should keep away from people who have not been vaccinated against chickenpox (especially newborns and young children, as well as pregnant people) and people who have a weak immune system.
Good to know: Although shingles itself cannot be passed from person to person, the varicella zoster virus which causes chickenpox can be transmitted through contact with the fluid in the rash blisters.[10]
Vaccination for herpes zoster infection
Vaccination against chickenpox (the varicella vaccination) and herpes zoster (a herpes zoster vaccination) can help to prevent and reduce the severity of some cases of shingles.
The Centers for Disease Control and Prevention recommends that all healthy adults aged 50 and older should receive the shingles vaccine. Depending on the age of the person receiving the vaccine, it is between 89 and 97 percent effective at preventing shingles and postherpetic neuralgia.[11][12]
FAQs for herpes zoster ophthalmicus
Other names for herpes zoster ophthalmicus
- Shingles affecting the eye
- Zoster Ophthalmicus
- Ophthalmic shingles
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Centers for Disease Control and Prevention. “Shingles.” October 2017. Accessed May 17, 2018. ↩
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American Family Physician. “Evaluation and Management of Herpes Zoster Ophthalmicus.” November 2002. Accessed May 17, 2018. ↩ ↩ ↩
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MSD Manual: Professional Version. “Herpes Zoster.” February 2018. Accessed May 17, 2018. ↩
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American Academy of Ophthalmology. “Herpes Zoster Ophthalmicus.” Accessed May 17, 2018. ↩ ↩ ↩ ↩ ↩
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The New England Journal of Medicine. “Herpes Zoster.” August 2002. Accessed May 17, 2018. ↩
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UpToDate. “Treatment of herpes zoster in the immunocompetent host.” April 2018. Accessed May 17, 2018. ↩
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American Academy of Ophthalmology. “Acute Retinal Necrosis.” Accessed May 17, 2018. ↩
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Cornea: the clear dome at the front of the eye. ↩
-
Ciliary body: the part of the eye behind the iris. ↩
-
Centers for Disease Control and Prevention. “Shingles:Transmission.” January 2018. Accessed May 17, 2018. ↩
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Centers for Disease Control and Prevention. “Shingles Vaccination.” January 2018. Accessed May 17, 2018. ↩
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MSD Manual: Professional Version. “Herpes Zoster Ophthalmicus.” December 2016. Accessed May 17, 2018. ↩
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Advances in Dermatology and Allergology. “Blindness resulting from orbital complications of ophthalmic zoster”. October 2015. Accessed 29 December 2018. ↩ ↩ ↩
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MSD Manuals Consumer Version. “Herpes Zoster Ophthalmicus
(Herpes Zoster Virus Ophthalmicus; Ophthalmic Herpes Zoster; Varicella-Zoster Virus Ophthalmicus)”. October 2018. Accessed 29 December 2018. ↩ -
American Family Physician. “Evaluation of the Painful Eye”. June 2016. Accessed 29 December 2018. ↩ ↩
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Clinical Infectious Diseases. “Recommendations for the Management of Herpes Zoster”. 1 January 2007. Accessed 29 December 2018. ↩
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Medscape. “What is herpes zoster ophthalmicus (HZO)?”. 12 February 2018. Accessed 29 December 2018. ↩
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Cleveland Clinic. “Herpetic Eye Disease”. 15 March 2015. Accessed 29 December 2018. ↩ ↩
**What is Herpes Zoster Ophthalmicus?**
**Q: What is Herpes Zoster Ophthalmicus (HZO)?**
**A:** Herpes Zoster Ophthalmicus (HZO) is a viral infection that affects the eye and the area around it. It is caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox. After a person has chickenpox, the virus can lie dormant in the body for years. In some cases, it can reactivate later in life, causing HZO.
**Q: What are the symptoms of HZO?**
**A:** Symptoms of HZO can include:
* Pain in the eye
* Redness in the eye
* Sensitivity to light
* Blurred vision
* Double vision
* Headache
* Fever
* Fatigue
**Q: How is HZO diagnosed?**
**A:** HZO is diagnosed based on a physical examination of the eye and a review of the patient’s medical history. The doctor may also order a blood test or a corneal scraping to confirm the diagnosis.
**Q: How is HZO treated?**
**A:** Treatment for HZO includes:
* Antiviral medications, such as acyclovir, valacyclovir, or famciclovir
* Topical corticosteroids to reduce inflammation
* Artificial tears to lubricate the eye
* Pain medication
**Q: What are the complications of HZO?**
**A:** Complications of HZO can include:
* Permanent vision loss
* Corneal scarring
* Glaucoma
* Cataracts
* Retinitis
* Optic nerve damage
**Q: How can I prevent HZO?**
**A:** There is no cure for HZO, but it can be prevented by getting the varicella vaccine. The varicella vaccine is a live vaccine that contains a weakened form of the VZV. The vaccine is given in two doses, one at 12-15 months of age and the other at 4-6 years of age.
**Q: Who is at risk for HZO?**
**A:** Anyone who has had chickenpox is at risk for HZO. However, the risk is highest in people who are over 60 years of age, people who have weakened immune systems, and people who take immunosuppressive medications.
**Conclusion**
Herpes Zoster Ophthalmicus (HZO) is a serious infection that can lead to permanent vision loss. It is caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox. There is no cure for HZO, but it can be prevented by getting the varicella vaccine.
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