SHINGLES AND THE EYES

Shingles is a medical condition that causes a painful blistering rash to form on the body and sometimes the face. It is related to the chickenpox virus, varicella zoster. If one has had chicken pox as a child, the virus remains dormant in the system, but can multiply in the nerve cells and re-emerge decades later.

SYMPTOMS OF SHINGLES

There are progressive stages to shingles. The first sign is a tingling or burning pain, often on one side of the body, usually in the area of the waist, back, chest or ribcage. Other symptoms may include a headache, low fever, fatigue or flu-like symptoms. Within two to three days, a rash will break out, with painful blisters appearing a few days later. The shingles virus travels along a nerve path, so the rash will often form a line along the body or face, typically localised to only one side. Eventually, the blisters will open, crust over, and heal. This can take anything from two to six weeks.

The shingles rash will fade after a few weeks, but the pain can continue for weeks or months, as a result of nerve damage. This is more common in older adults, and in most people, the nerve pain will improve over time.

SHINGLES IN THE EYE

About 10 to 20 percent of people with shingles develop shingles in and around the eye. This type of shingles is called ophthalmic herpes zoster, or herpes zoster ophthalmicus. The symptoms tend to follow a similar course to shingles on the body, starting with pain on one side of the head, followed by puffiness, redness and pain in or around the affected eye, as well as watering, blurred vision, and extreme sensitivity to light. The blistering rash forms on the eyelids, forehead, and possibly the tip or side of the nose. The rash may appear at the same time as the body rash or weeks later, and sometimes it does not appear on the body at all, and is only present on the face and eye.

In severe cases swelling of the cornea may leave permanent scars. Shingles can also cause swelling of the retina, or increased eye pressure which may lead to glaucoma. Treating shingles in the eye as early as possible can help to avoid long-term complications.

Herpes zostes opthalmicus does not always happen because of the virus being in the optic nerve. The virus can get to the eyes by contact from a body part that has the virus. Be aware of not touching the eyes or face if you have shingles, and wash your hands regularly.

RISK FACTORS FOR SHINGLES

About 1 out of 5 people who had chickenpox as a child will get shingles. Factors that increase the risk of shingles include childhood chickenpox, a weakened immune system due to chronic illness, certain medications, or excessive stress.

DIAGNOSIS OF SHINGLES IN THE EYE

By taking a detailed case history and looking at the rash on the eyelids, scalp or body, a doctor should be able to diagnose shingles. A sample of fluid may be taken from the blisters and sent to a laboratory to confirm the virus. An optometrist will examine the cornea, lens and retina, and check eye pressure to detect swelling and damage due to the virus.

TREATMENT OF SHINGLES

In general, shingles is a disease that gradually disappears by itself once it has run its course, but if picked up early enough, treatment can reduce the duration and side effects. Most prescribed medicines are for the relief of pain. The discomfort in the area around the eye can also be relieved by the use of topical creams that contain calamine. Antivirals may be prescribed to decrease the extent and length of the recovery period and to stop the spread of shingles.

One other option that has been made available for those suffering from severe acute pain is the use of steroids to relieve immediate pain. Although they work for that moment, they do not seem to reduce the potential of pain in the future. To reduce swelling in the eye, a steroid medicine in the form of a pill or eye drops may also be prescribed. It is sometimes helpful to use eye drops that keep the pupil dilated to prevent spasms in the eye muscles and ease pain.

The rash might start to look better after a few days, but still be painful. That doesn't mean that treatment isn't working. The medications will do their job, and the pain will go away, but it usually takes time.

PREVENTION OF SHINGLES

A vaccine is available, which has been found to reduce the risk of getting shingles considerably, as well as to minimise the long-term effects. Shingles can strike more than once, and the vaccine may prevent this to some extent.

If you have shingles, prevent transmission of the disease by keeping the rash covered and avoiding direct contact with others during the contagious stage. This is particularly important for pregnant women and those with a weakened immune system.

Try to avoid close contact with anyone who's never had chickenpox. A person who has never had chickenpox can catch the varicella- zoster virus, but they will develop chickenpox and not shingles.

Try to avoid scratching the rash to prevent it spreading to other parts of the body.

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