Shingles is a disease that causes a painful, blistering rash to form on the body and sometimes the face. The varicella-zoster virus causes it. This is the same virus that causes chickenpox. Once you’ve had chickenpox, the virus stays in your system. It can reemerge decades later as shingles.
In about 10 to 20 percent of people with shingles, the rash appears in and around the eye. This type of shingles is called ophthalmic herpes zoster, or herpes zoster ophthalmicus. Shingles in the eye can cause scarring, vision loss, and other long-term problems. You can prevent shingles of the eye and its complications by getting vaccinated if you’re over age 50.
Symptoms of shingles
The first shingles symptom most people notice is a tingling or burning pain, often on one side of their body. The feeling is often in the trunk area, which includes the:
Other early signs are:
- a headache
- a low fever
- flu-like symptoms
Within two to three days, reddened skin and a rash will appear in the area where you felt pain. The shingles virus travels along a nerve path, so the rash will often form a line on one side of the body or face.
Within a couple of days, painful blisters will pop up on the rash. These blisters will eventually open, and they might bleed. The blisters will gradually crust over and start to heal. The shingles rash can last for two to six weeks.
Symptoms of shingles in the eye
When you have shingles in the eye, the blistering rash will form on your eyelids, forehead, and possibly on the tip or side of your nose. This rash might show up at the same time as the skin rash, or weeks after the skin blisters have gone away. Some people only have symptoms in their eye.
Along with the rash, you might have:
- burning or throbbing pain in your eye
- redness around and in the eye
- tearing or watery eyes
- eye irritation
- blurry vision
- extreme sensitivity to light
You might also have swelling in parts of your eye, such as:
- your eyelid
- your retina, which is the light-sensitive layer in the back of your eye
- your cornea, which is the clear layer in the front of your eye
If you have one or more of these symptoms, call your primary care doctor or an eye doctor for an appointment. The sooner you get treatment, the less likely it is that you’ll have long-term complications.
Risk factors for shingles
Once you’ve had chickenpox as a child, you’re at risk of getting shingles later in life. The virus stays dormant, or asleep, in your body. It hides out in nerve cells near your spinal cord, but it can become active again when you’re older.
You’re at increased risk of getting shingles if you:
- had chickenpox as a child
- are age 50 or older because your immune system weakens as you age
- have a weakened immune system because of a disease like cancer, HIV infection, or AIDS
- take medicine that weakens your immune system, such as chemotherapy or radiation for cancer, or stops your body from rejecting a transplanted organ
- are under stress
Shingles is especially serious in some groups of people, including:
- pregnant women
- premature infants
- people with a weakened immune system
Complications of shingles in the eye
The shingles rash will fade after a few weeks, but the pain can continue for many more weeks or months. This complication is caused by nerve damage called postherpetic neuralgia, which is more common in older adults. In most people, the nerve pain will get better over time.
In the eye, swelling of the cornea may be severe enough to leave permanent scars. Shingles can also cause swelling of the retina. It can also increase eye pressure and lead to glaucoma. Glaucoma is a disease that damages the optic nerve. You can also develop an injury to the cornea.
Treating shingles in the eye right away can help you avoid long-term problems, including permanent vision loss.
Diagnosis of shingles in the eye
Your doctor should be able to diagnose shingles just by looking at the rash on your eyelids, scalp, and body. Your doctor might take a sample of fluid from the blisters and send it out to a lab to test for the varicella-zoster virus.
An eye doctor will examine:
- your cornea
- your lens
- your retina
- other parts of your eye
They’ll look for swelling and damage that occur due to the virus.
Treatment of shingles in the eye
Doctors treat shingles with antiviral medicines, such as:
These medicines may:
- stop the virus from spreading
- help the blisters heal
- help the rash fade more quickly
- relieve pain
Starting the medicine within three days after your rash appears can help you avoid long-term shingles complications.
To reduce swelling in your eye, your doctor might also give you a steroid medicine in the form of a pill or eye drops. If you develop postherpetic neuralgia, pain medicine and antidepressants can help relieve the nerve pain.
Outlook for people with shingles in the eye
Your shingles rash should heal within one to three weeks. Symptoms around your face and eyes can sometimes take up to a few months to heal.
In the early stages of the disease, your doctor will check you every few days. After you’ve received treatment for the infection, you’ll probably need to see your eye doctor every 3 to 12 months to check for glaucoma, scarring, and other long-term problems that can affect your vision.
You can avoid this disease by getting the shingles vaccine. The Centers for Disease Control and Prevention officially recommends it for people age 60 and older, but the U.S. Food and Drug Administration has approved a vaccine for use by people age 50 and older. Ask your doctor when you should get vaccinated. Research finds the vaccine can cut your risk of getting shingles by more than 50 percent, and it can reduce your odds of long-term nerve damage by more than 66 percent.
If you do get shingles, try to avoid close contact with anyone who’s never had chickenpox. This is especially important during the contagious stage, when you have blisters on your skin. A person who has never had chickenpox can catch the varicella- zoster virus, but they’ll have chickenpox and not shingles.
- Stay away from anyone who is pregnant or who has a weakened immune system. Shingles is especially dangerous for them.
- Keep your rash covered to reduce the likelihood of spreading it.
- Try to avoid scratching the rash.
- Wash your hands after touching the rash.