Shingles In The Eye: Symptoms, Causes, And Treatment

Shingle is a viral infections that can affect different body parts, including in and around the eyes. This type of shingles is called herpes zoster ophthalmicus (HZO). 

When shingles in the eye occur, a person will experience a band of rash or painful blisters around the eye. The small and excruciating blisters may also cover the skin of the forehead and tip of the nose.

Shingles in the eye can be dangerous, causing scarring, vision loss, and other long-term complications.

On the bright side, there are ways to manage and even prevent eye shingles. Continue reading to learn more about this condition, its causes, symptoms, possible treatments, etc.

What are shingles in the eye, and how do you get them?

Shingles, also known as herpes zoster, is a viral infection caused by the varicella-zoster virus. When this virus first enters your body, it causes chickenpox, which is common among children. The body can create immunity against the virus, thus preventing subsequent chickenpox attacks.

But even after treatment, the virus doesn't go away completely. It stays dormant in the body for the rest of your life. If your immunity is weakened at any point, the virus may reactivate, and that's when it causes shingles.

The active virus travels along the nerves, meaning that shingles can occur on any part of the body connected to nerves. Shingles commonly occur on the chest, back, abdomen, or legs, but you can also get it on your face and eyes. 

Remember that having shingles in the eye doesn't always mean eye involvement. It is estimated that 8–20% of people suffer from herpes zoster ophthalmicus and only 50% of them have ocular involvement.¹

Most people with herpes zoster ophthalmicus will experience a rash on one side of their face. The rash often starts as small, red bumps that turn into blisters. Eventually, the blisters will burst and form scabs, which can fall off and leave scars.

The eyes have a complex set of nerves and blood vessels, meaning shingles in the eyes can do a lot of damage. Of course, this will depend on the part of the eye that is affected.

Risk factors for shingles

Reportedly, one in three people in the US will have shingles in their lifetime, making it a fairly common infection. Anyone who's had chickenpox before can get shingles. That's because the virus that causes chickenpox becomes dormant in the body after treatment. It later reactivates to cause shingles.²

Several factors can increase the likelihood of the varicella-zoster virus reactivating. A weakened immune system is one risk factor, as your body is less able to fight off viruses, thus allowing the varicella-zoster virus to come alive.

Several factors can cause a weakened immune system, including:

• Aging

• High stress

• Taking immunosuppressant medications

• Having another illness like cancer or HIV

What do shingles in the eye look Like?

As mentioned earlier, HZO typically affects just one eye or side of the face. You will first experience pain in or around your eyes, which can develop into a red rash on the skin. The rash forms lesions or fluid-filled blisters, which eventually scab or crust.

The blisters may appear on the skin around the eye (the periocular skin or eyelid). Most people will also have a rash and blisters on the forehead and nose.

The shingles virus often travels along a nerve path. So, expect the rash to form in a line or on one side of your face. This is the biggest way to differentiate between a shingles rash and other types of rashes.

Shingles in the eye can cause further eye problems, such as uveitis, keratitis, retinitis, and conjunctivitis. These conditions can cause the eye to become inflamed and appear pink/red or discolored with visible scars or lesions.

Symptoms of shingles in the eye

This infection can cause several symptoms. You might first experience a tingling or burning pain on one side of your face. The pain might be constant or come and go.

In two or three days, a rash and reddened skin usually form where you felt the pain.

Painful blisters will then pop up in the rash area, which can be sore and itchy. The blisters eventually burst, start to crust over, and heal. Keep in mind that the rash can last for two to six weeks.

Other symptoms of eye shingles include:

• Facial tingling

• Eyelid swelling and redness

• Swelling in other parts of your eye, like the retina and cornea

• Difficulty moving the eye (optic nerve palsy)

• Blurred, clouded, or decreased vision

• Watery eye

• Sensitivity to light

Some people only have symptoms in the eye, while others may experience blistering on the forehead, nose, and around the eye. You may also experience generalized shingles symptoms, which include:

• Headache

• Fever

• Fatigue

• Nausea

• Flu-like symptoms

These symptoms can signify other eye conditions, like preseptal cellulitis and herpes simplex. It's best to consult a doctor for the correct diagnosis and treatment plan!

Possible complications of shingles

The eyes are quite delicate and can easily get infected or damaged. As such, shingles in the eye are not something to ignore.

Shingles cause itchiness, redness, inflammation, and pain. All this can harm the delicate surfaces of the eye, including the underlying components of the eye.

For starters, inflammation will cause swelling, which then increases the pressure of your eye. This can alter vision and even cause glaucoma if not controlled.

The itchiness can cause excessive eye rubbing, possibly leading to micro-scratches and scarring in the eye. The scratches can also impact vision and increase the risk of bacterial infection.

If the disease targets the optic nerve, it can leave sufferers completely blind.

Shingles can also lead to other complications, such as nerve damage (postherpetic neuralgia), stroke, pneumonia, brain inflammation, and so on.

One of the most common complications of shingles is postherpetic neuralgia. This pain lingers long after treatment has occurred and the rash has cleared. It can sometimes be severe, thus affecting one's daily life. The pain can be chronic or recurrent, lasting for months or even years.

How to diagnose shingles in the eye

Your doctor will need to perform an eye examination to determine if you have herpes zoster on your eye. Because of the unique placement of the shingles rash on only one side and the typical painful blistery features, many doctors can diagnose shingles by sight.

Further tests may be necessary if the rash is not distinctive. This may involve swabbing the eye or taking a fluid sample to test for the varicella-zoster virus. 

The doctor will also examine your medical history to see if you've had chickenpox. 

Treatment for shingles in the eye

While shingles don’t have a cure, some treatments help alleviate symptoms. Seeking early treatment is also key to avoiding or lowering your risk of complications.

Once a diagnosis has been confirmed, you'll receive the following treatments:

Antiviral medications

Doctors manage shingles with antiviral drugs such as:

• Acyclovir (Zovirax)

• Famciclovir (Famvir)

• Valacyclovir (Valtrex)

These drugs work by stopping the virus from spreading. They also help the blisters to heal, relieve pain, and help the rash to fade away faster.

Other treatments are available depending on the specific case. Possible treatments include anti-inflammatory drugs to reduce swelling, steroid eye drops, painkillers, and antidepressants for nerve pain. Some situations may require eye surgery or debridement.

At-home care

Some at-home treatments can further improve the symptoms and speed up recovery.

For starters, if you have a rash or blisters, you must keep the infected area clean and dry. Also, avoid scratching and unnecessary touching to reduce scarring and the risk of infection. The blisters will crust over and fall off on their own.

A cold compress or cool bath/shower can help soothe the pain. You can also apply calamine lotion on the blisters but ensure you don't get any in your eye.

Get an ophthalmologist involved

Herpes zoster ophthalmicus could affect your eye, leading to possible complications such as blindness. So, as well as treating the shingles, you’ll need additional treatment for your eye problems. Be sure to get an ophthalmologist to determine the best course of treatment.

Preventing shingles

As we've seen throughout this text, shingles is caused by the reactivation of the virus that causes chickenpox. So, the first step to preventing shingles is preventing chickenpox through vaccination.

The following line of defense for those who've had chickenpox is Shingrix, the shingles vaccine. The vaccine lowers the risk of infection by at least 90% for people 50 and over. Even if you do get shingles, symptoms are typically less severe. The vaccine also reduces the risk of possible complications.³

The Centers for Disease Control and Prevention (CDC) recommends two vaccine doses for people aged 50 and above.

You may come across some websites recommending a shingles vaccine called Zostavax — this is an older vaccine, and it is no longer available in the US. Plus, the FDA approved Shingrix as a more effective vaccine than Zostavax.⁴

The lowdown

Herpes zoster infection involving the eye is a serious condition. It can present as pain, redness, sensitivity to light, and blurred vision. Early treatment with antiviral medications is essential to prevent long-term damage to the eye.

If you suspect you have shingles in the eye, seek urgent medical attention.

FAQs

How long do shingles in the eye last?

The outlook can vary depending on individual factors — for instance, a person's previous condition, the severity of the infection, and how quick and effective the treatment is.

According to the National Institute on Aging, this condition can take up to five weeks to clear.⁵

Even after the herpes zoster ophthalmicus outbreak has settled, you may be advised to have regular eye checkups with your ophthalmologist. This is to ensure there are no secondary complications, such as glaucoma, scarring, and other long-term eye problems, that can develop due to shingles in the eye.

How common are shingles?

Shingles are quite common, with one in every three people in the US getting infected in their lifetime. From children to adults to seniors, anyone can get shingles.

The risk of this infection increases with age. And it is estimated that about half of the people who reach 85 years of age will get shingles at some point.

Are shingles contagious?

No, but it involves a reactivation of the varicella-zoster virus, also known to cause chickenpox. This means that you can infect people who have never had chickenpox before. Children, pregnant women, and anyone with a compromised immune system are also at high risk of contracting the virus.