Dr Ben Wild
Overview |
The contents of the orbits of the skull include many tissues such as the optic nerves, extensions of the trigeminal nerves, orbital fat, eye muscles, the lacrimal glands, the eyes themselves, and much more.
A frontal view of a healthy eye.
Herpes zoster ophthalmicus (HZO), aka shingles involving the eye, refers to when the zoster virus (same as the chickenpox virus) exits the trigeminal nerve and infects the tissues of the orbit and the skin on half of the face. The skin rash covers exactly either the right or left side of the face and is a tell-tale sign when it comes to shingles. If the rash extends to the tip of the nose there is a much higher chance the virus will also affect the eye and cause conjunctivitis, keratitis, vasculitis, episcleritis, scleritis, uveitis, neuritis, nerve palsies, neuralgia, neurotrophic ulcers or others. It usually occurs in the 6th and/or 7th decade of life and becomes more severe in immunodeficient people.
Front view of an eye with HZO including a skin rash, conjunctivitis and keratitis.
Shingles usually has a fairly sudden onset and presents alongside tiredness, fever, feeling unwell, and itching, tingling, and burning of the skin.
Signs and Symptoms |
Signs
Rash covering either left or right of the face, eyelid swelling, and red eye.
Symptoms
Eye pain, light sensitivity, burred vision.
Causes and Risk Factors |
Causes
Varicella zoster virus infection.
Risk Factors
Stress.
Prevention and Treatment |
Prevention
Childhood infection with chickenpox and receive the varicella zoster vaccine (prevents infection in 82% of cases and 100% of severe cases).
Treatments
Treatment starts with either acyclovir, famciclovir, or valacyclovir anti-viral pills, ideally within the first 3 days, followed by other add-ons depending on which tissue is affected.
· Conjunctivitis: artificial tears and cold compresses for comfort.
· Keratitis: artificial tears and steroid drops.
· Episcleritis: non-steroidal anti-inflammatory drops.
· Scleritis, vasculitis, neuritis: steroid pills.
· Uveitis: steroid pills or drops.
· Nerve palsies and neuralgias: no treatment.
Prognosis |
Mild to moderate HZO is usually easily treatable with the facial rash lasting a week or two. Full recovery from mild to moderate cases is likely. Severe cases of HZO can cause permanent corneal scarring, nerve damage, permanent neuralgia pain, cataracts, glaucoma, retinal scarring and in worst case scenarios, can lead to removal of the eye.