What is ocular shingles?
Ocular shingles (herpes zoster ophthalmicus) is an inflammation of the eye and surrounding skin caused by an infection of a virus in the Herpes group called the Varicella Zoster virus (the Chicken Pox virus). The name, shingles, comes from a Latin word meaning belt or girdle, as shingles usually presents as a rash along the path of a nerve in a band-like pattern.
What causes shingles?
Shingles is caused by the Chicken Pox virus that reactivates after years of “hibernation” in the nerve cells. When you contract Chicken Pox, the virus takes refuge inside nerve cells and remains there for life after the rash goes away. This is a common behavior of all viruses in the Herpes group. Years later, when the immune system “forgets” the virus, it re-emerges as shingles.
Why is shingles becoming more common?
Currently, it is estimated that half of all people will develop shingles during their lifetime. The reason appears to relate to the use of the Chicken Pox vaccine. Prior to vaccination, adults would be routinely exposed to the Chicken Pox virus as they were intermittently exposed to children with active Chicken Pox. This frequent exposure to the virus by adults used to keep the immune system primed to keep the virus contained inside the nerve cells. Now that children no longer contract Chicken Pox, adults no longer receive the benefit of immune priming. Over time the immune system forgets the virus and allows the escape of the virus from the nerve.
What are the symptoms of ocular shingles?
The symptoms of shingles depend on the location of the nerves that harbor the virus. If the chest wall is affected, the eyes are spared. If the trigeminal nerve is affected, the forehead develops a rash. If the rash reaches the tip of the nose, the eye is often affected. The rash starts with redness and tiny blisters that crust and scar over time. Pain may occur before the rash appears and is described as burning, sharp, jabbing or tingling. Pain may be severe. It is the persistence of pain that may be disabling.
Aside from the possibility of long-term pain, other problems may relate to shingles. There appears to be an increased risk (4.5x) of stroke after shingles. There may also be an increased risk of cancer, inflammation of blood vessels (temporal arteritis), heart attack, and depression.
Ocular shingles is when shingles affects the eye. It may cause inflammation of the front window of the eye (the cornea) with scarring. Glaucoma may occur and require life-long treatment to prevent blindness. Intraocular inflammation may affect the front of the eye (iritis) or deep inside the eye threatening loss of vision. The inflammation may persist or return intermittently into the future.
What treatment is available?
Antiviral and anti-inflammatory medications may help treat shingles. The systemic treatment of shingles is managed by an internal medicine doctor (and sometimes by an infectious disease specialist). Treatment may hasten the recovery from shingles, but does not eliminate the late complications of infection.
Ocular complications of shingles are treated by ophthalmologists. Apart from anti-viral pills, eyes drops can help prevent loss of vision. After the initial inflammation is controlled, regular exams are important to diagnose problems that may occur in the future.
What can be done to prevent shingles?
An ounce of prevention is worth a pound of cure. The chance of shingles can be reduced by the use of a vaccine. This vaccine reduces the risk, but does not eliminate the chance of getting shingles. If shingles does occur after vaccination, it us usually not as severe compared to those without the vaccine. Not surprisingly, the effect of the vaccine wears off over a period of five to ten years. Research suggests that booster shots may help extend the effect of the vaccine; however, the cost of the vaccine appears to hinder formal recommendations for repeat vaccination. The newest vaccine, Shingrix, became available in 2018 and offers the best protection.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida.
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