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Let’s talk about pain: shingles and the eye

Eye Practice
Let’s talk about pain: shingles and the eye

Many people have been exposed to the chicken pox (varicella zoster) virus as children. But the virus can hide in your nerves for years and reappear later in life – typically after 65 years of age.

This is shingles, or herpes zoster, which presents as a painful blistering skin rash usually limited to a wide stripe on one side of the face, head or body. It frequently affects the eye.

 

What happens in the eye?

One of the most commonly-affected nerves is called the trigeminal nerve, one branch of which is the ophthalmic nerve – which brings sensation to the eye. If this branch is affected by shingles (up to 25% of the time), there are a number of effects in the eye, including keratitis (inflammation of the cornea), conjunctivitis, uveitis and more. Some of these can be sight-threatening, especially if not managed early enough.

Uveitis caused by the herpes zoster virus is usually an inflammation of the iris and ciliary body of the eye. But it can also affect the retina.  One of the signs of this disease is very high intraocular pressure, which can cause glaucoma, or permanent damage to your optic nerve if not managed properly. Treatment will usually involve steroid eye drops for weeks or months, oral or intravenous anti-viral medications, as well as pressure-lowering eye drops. Your cornea can also be inflamed and require steroid eye drops.

 

Post herpetic neuralgia – PHN

Shingles is associated with a number of eye problems, some of which are very serious, but the most debilitating thing about it is the nerve pain that can persist even after the rash has healed. This is called post-herpetic neuralgia (PHN) and occurs in nearly half of all shingles patients over the age of 70. Although this pain is not necessarily felt directly in the eye, it can be in the skin area around the eye if that area was affected by the disease. PHN can be severe and extremely debilitating and is one of the leading causes of depression and suicide in the elderly.

 

If I get it, is it too late?

If you DO get shingles – evident by a blistering and usually painful rash on one side of your face, head or body – it is important to see your GP immediately. Tingling in the skin can happen a few hours to a day before the first blisters appear, so if you experience this sensation (similar to a cold sore coming on), consult with your doctor. You may also get headache, fever and feel unwell. Oral anti-viral medication can reduce not only the symptoms and duration of the disease, but also the incidence of PHN significantly. But you need to take the tables within the first 3 days of the disease in order for this to occur.

 

Vaccine for shingles


Most people are vaccinated against chicken pox these days, but immunity can wear off. A shingles vaccine is available in Australia since November 2016 and is an effective way to protect against the disease. It is available for free for patients over 70 years of age. (Younger patients will pay about $200 for the vaccine).
Shingles can have serious implications for both your eye health and your quality of life (if post herpetic neuralgia is present. See your therapeutically-endorsed optometrist immediately if you develop a skin rash around the eye.

Sore, red eyes? Come and see the experts. Call The Eye Practice on (02) 9290 1899 or make an appointment online today.

 

 


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