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Herpes Zoster Ophthalmicus

  1. What is herpes zoster ophthalmicus?
  2. Symptoms
  3. Causes
  4. Diagnosis
  5. Treatment
  6. Complications
  7. Prevention
  8. FAQs
  9. Other names for herpes zoster ophthalmicus

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 a painful, blistering rash over the face and eye, and eye pain and redness on the same side as the rash. If you are concerned that you may have this condition, you can try using the Ada app 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.

Herpes zoster ophthalmicus can cause permanent vision problems if not treated quickly. It is important to see a doctor without delay.

Symptoms of herpes zoster ophthalmicus

Ophthalmic shingles often begins 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 immunosuppressed people 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

As well as the rash, people with herpes zoster ophthalmicus often develop a painful, watering eye on the same side as the rash, along with swelling around the eye and, in some cases, ocular problems. Worried you may have herpes zoster ophthalmicus? You can try using the Ada app 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

People at risk of developing ophthalmic shingles are those who have previously had chickenpox. 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 a person is immunosuppressed. 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 opthalmic nerve 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.

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.

Complications of herpes zoster ophthalmicus

Possible complications of herpes zoster ophthalmicus include:[^2[7]

  • Conjunctivitis: Inflammation of the lining of the eye (read more about conjunctivitis)
  • Keratitis: Inflammation of the cornea, which could lead to visual impairment[8]
  • Blepharitis: Inflammation of the eyelid
  • Uveitis: Inflammation of the iris and ciliary body[9] in the eye (read more about uveitis)
  • 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: Which 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 people who have a weak immune system. 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 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

Q: Is herpes zoster ophthalmicus contagious?
A: Herpes zoster ophthalmicus itself is not contagious. However, it is possible for someone with this condition to pass on the varicella virus that causes chickenpox through contact with fluid from the rash blisters.

Q: Is herpes zoster ophthalmicus the same as herpes keratitis?
A: Herpes keratitis is caused by the herpes simplex virus, the same virus which causes cold sores and genital herpes. Infection can be spread to the eye by touching an active lesion and then the eye. It specifically affects the cornea of the eye and symptoms include pain, redness, a rash and blurred vision, and can lead to permanent vision problems.

Herpes zoster ophthalmicus is caused by the varicella virus which causes chickenpox. The virus stays dormant in the body and can later reactivate and cause herpes zoster, otherwise known as shingles. Sometimes shingles affects the eye, and can cause keratitis as a complication.

Other names for herpes zoster ophthalmicus

  • Shingles affecting the eye
  • Zoster Ophthalmicus
  • Ophthalmic shingles

  1. Centers for Disease Control and Prevention. “Shingles.” October 2017. Accessed May 17, 2018.

  2. American Family Physician. “Evaluation and Management of Herpes Zoster Ophthalmicus.” November 2002. Accessed May 17, 2018.

  3. MSD Manual: Professional Version. “Herpes Zoster.” February 2018. Accessed May 17, 2018.

  4. American Academy of Ophthalmology. “Herpes Zoster Ophthalmicus.” Accessed May 17, 2018.

  5. The New England Journal of Medicine. “Herpes Zoster.” August 2002. Accessed May 17, 2018.

  6. UpToDate. “Treatment of herpes zoster in the immunocompetent host.” April 2018. Accessed May 17, 2018.

  7. American Academy of Ophthalmology. “Acute Retinal Necrosis.” Accessed May 17, 2018.

  8. Cornea: the clear dome at the front of the eye.

  9. Ciliary body: the part of the eye behind the iris.

  10. Centers for Disease Control and Prevention. “Shingles:Transmission.” January 2018. Accessed May 17, 2018.

  11. Centers for Disease Control and Prevention. “Shingles Vaccination.” January 2018. Accessed May 17, 2018.

  12. MSD Manual: Professional Version. “Herpes Zoster Ophthalmicus.” December 2016. Accessed May 17, 2018.