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Let’s talk about pain: shingles and the eye

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

Shingles is the disease caused when the chicken pox virus reactivates. It is associated with eye problems, some very serious, but the most debilitating thing is the nerve pain that can persist even after the rash has healed. 

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. The rash will only be present on one side, and stop suddenly when it reaches the mid-line of your body or face, as in the image below. 

 

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 (which happens 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.

Shingles can also cause uveitis, an inflammation of the iris (coloured part) of the eye. But it can also affect the retina.  One of the signs of this disease is very high pressure inside the eye, which can cause glaucoma, or permanent damage to your optic nerve if not managed properly. Treatment for uveitis usually involves 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 (this is called keratitis) and require steroid eye drops.

 

Post herpetic neuralgia – PHN

Perhaps the worst thing about shingles is the nerve pain (neuralgia) that can persist for several months after the rash. 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 shingles, 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 - the same day if possible. 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. 

Here's the important thing: In terms of managing pain, 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 and safe way to protect against the disease. The vaccine is available for free* for patients aged 70-79 years of age. (Other people will pay about $200 for the vaccine). 

The shingles vaccine is also recommended (but not free) for:

  • adults aged 60 to 69 years
  • adults 80 years and older
  • adults aged 50 or over who live in the same household as someone who has a weakened immune system

What about side effects?

All medications have side effects. For safe medicines and vaccines, such as the shingles vaccine, the side effects are likely to cause far less harm than the disease itself.  Your doctor will discuss side effects with you prior to getting vaccinated. Common side effects include:

  • pain, redness, swelling or itching of the site (where you had the needle)
  • headache
  • tiredness


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 or GP 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.

 

 * Note: while the vaccine itself is free for certain people, you may still be charged an out of pocket fee by your doctor or nurse to administer the vaccine. 

This article was originally posted in Nov 2017 and has been updated for accuracy and currency. 

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