Shingles in the Eye

Shingles in the eye is a painful infection caused by the same virus that causes chickenpox. Its medical name is herpes zoster ophthalmicus (HZO).

It happens when the shingles virus becomes active in nerves around your eye. Most of the time, it affects just one of your eyes. But in rare cases, it can show up in both at the same time.

This condition can be serious. Along with being very painful, eye shingles can affect your vision and even permanently damage your eyes. That’s why it’s important to see a healthcare provider right away if you notice any symptoms.

Symptoms of shingles in the eye

The most common symptoms include:

• A painful rash on your face and forehead around your affected eye
• Severe eye pain
• Burning, shooting nerve pain
• Swelling around your eye, especially your eyelid
• Pink eye or red eye
• Light sensitivity
• Fever
• Headache
• Fatigue

You might notice pain or tingling in your face before other symptoms. Healthcare providers call these warning signs a prodrome. It’s similar to how people who get migraine headaches can sometimes sense them coming on.

The shingles rash usually follows the path of the affected nerves. The bumps and sores may branch across your face, on the tip of your nose and around your affected eye. The rash will have lots of little bumps grouped close together. The bumps can break open, and then form scabs. Try not to touch or scratch them.

HZO causes

The same virus that causes chickenpox causes all types of shingles. It’s the varicella-zoster virus (VZV).

Most people have chickenpox when they’re children. But it stays in your body after you get better. It’s not gone, just deactivated.

The inactive virus collects in your nerve cells. It doesn’t cause symptoms until it reactivates. The virus can be dormant in your body for a long time before it reactivates. Eye shingles can develop years after you’ve had chickenpox. It sometimes happens decades later.

Usually, your immune system keeps VZV dormant. It will stop the virus from reactivating. But if something weakens your immune system, the virus can turn itself back on. If it activates in nerves near your eyes, that’s when you get eye shingles.

Risk factors

Anyone with the varicella-zoster virus in their body can develop eye shingles. But you’re more likely to if your immune system is weaker.

Eye shingles is most common in people over 50. That’s because your immune system naturally loses strength as you age.

Living with a compromised immune system also increases your risk. Other health conditions and infections can lower your immune system’s power. Examples include:

• HIV/AIDS
• COVID-19
• Diabetes
• Other autoimmune diseases

Your immune system can also be weakened by some medications or treatments, including:

• Corticosteroids or other immunosuppressants
• Chemotherapy
• Receiving a stem cell or organ transplant

You may have a higher risk if you experience too much stress or anxiety. This can be hard to prove. But stress and other mental health issues can affect your physical health.

Complications of this condition

Shingles can cause inflammation in every layer of your eye, including your:

• Cornea
• Conjunctiva
• Retina
• Uvea

This may cause scarring and permanent damage if it’s not treated soon enough. That may lead to low vision or blindness.

You may feel some pain, tingling or other sensations in your affected nerves, even after you get better. It usually goes away over time. But some people have long-term or permanent nerve damage. Getting treatment as soon as possible is the best way to avoid this.

How doctors diagnose this condition

A healthcare provider will diagnose shingles in the eye with a physical exam and tests. Your provider will examine your eye and face. They’ll look at the rash and ask when it started. Tell your provider which symptoms you’ve experienced, when they started and how suddenly they developed.

Your provider will check for inflammation and increased pressure in your eye. You may need a few tests, including:

• Slit lamp exam
• Visual acuity test
• Tonometry
• Dilated retina exam

How is shingles in the eye treated?

Your healthcare provider will suggest treatments to help prevent damage to your eye and nerves. You can manage shingles symptoms, but there’s no cure. Reducing inflammation in your eye is the best way to prevent complications. You may need:

• Antiviral medication: This will help your body fight the infection.
• Gabapentin: This prescription medicine reduces nerve pain.
• Corticosteroids: These are prescription anti-inflammatory medications. They might be pills you take by mouth or eye drops. You may need a cream or ointment that you gently apply to the rash on your face.
• Pupil dilation: Your provider might dilate your pupil with medicated eye drops. This can reduce extra pressure inside your affected eye.
• Antibiotics: Eye shingles is a viral infection. But bacteria on your skin can get into your body more easily when you have open sores like the rash. You might need a course of antibiotics to help prevent this.

Your provider might recommend other ways to manage symptoms, like:

• Using artificial tears
• Gently putting a cold compress on your eye
• Taking over-the-counter pain relievers, like NSAIDs or acetaminophen (check with your provider before taking these)

When should I see my healthcare provider?

Visit a healthcare provider as soon as you notice any signs or symptoms that you think might be shingles in your eye. The sooner a provider diagnoses the infection, the quicker you can start treating it. It’s important to get it diagnosed right away to prevent permanent damage.

What can I expect if I have herpes zoster ophthalmicus?

It can be hard to estimate how long shingles in the eye will last. Every body responds to the infection differently. But the rash and other symptoms usually last for a few weeks.

What you can expect depends on a few factors:

• Your age
• How quickly you receive treatment
• The infection’s severity

It can be very painful to have shingles. That’s especially true when it’s on your face and near your eye. Talk to your provider if it seems like pain or other symptoms aren’t getting better. They may be able to adjust your treatments.

Don’t share bedding, towels or toiletry items with anyone while you have shingles. Just like chickenpox, the virus can spread through contact with the rash. Don’t wear contact lenses until your provider says it’s OK.

Keep taking all of your medications until your provider says not to. Even if you feel better, you need to take antivirals and antibiotics for the full course.

Can this be prevented?

If you’ve had chickenpox, you can reduce your risk of shingles by getting a shingles vaccine. Talk to a healthcare provider if you’re interested in a vaccine. They’ll let you know if it’s right for you.