What is herpes zoster ophthalmicus?

Herpes zoster ophthalmicus, also known as Shingles, is an infection of the nerves caused by the varicella-zoster virus (VZV), which causes chickenpox and shingles. The infection develops in one side of the face or scalp and can spread to both sides of the face, scalp, eye area and ear canal. The virus that causes chickenpox generally remains dormant in your body, however, it can reactivate to cause herpes zoster ophthalmicus at any time in your life.


It’s estimated that one in five people will develop shingles in their lifetime. Although you’re most likely to get herpes zoster if you’re older than 50, younger people can also contract it (and it happens more often in men than women).

Besides rashes, other symptoms of herpes zoster include fever, body aches and pains, and tingling or a burning sensation on your skin where your rash appears. You may also experience sensitivity to light, blurry vision, and eye pain or redness. Although there’s no cure for shingles itself, its painful symptoms can be treated with antiviral drugs like acyclovir. In some cases, doctors recommend shingles prevention vaccines such as Zostavax.

Before getting shingles, you need to make sure you’re not infected with chickenpox. Chickenpox and shingles are caused by two different viruses—varicella-zoster virus and herpes zoster virus—and they can be confused with each other. The good news is, a vaccine against chickenpox (varicella) exists, so if you had it as a child or received it as an adult, your chances of developing shingles will go down. If you were vaccinated against chickenpox but got infected later in life anyway, your body may still produce antibodies that reduce your risk of contracting herpes zoster again later on.

herpes zoster ophthalmicus
herpes zoster ophthalmicus

Herpes Zoster ophthalmicus Symptoms

An outbreak of shingles can affect one side of your face and/or your eye. They will both likely be red and painful. The skin around them may look discolored or bruised, with areas that seem lighter or darker than others. Blisters (vesicles) will form at some point, as well as crusts (scabs). Infected areas might be itchy and burn or feel like they’re burning, throbbing, or tingling. You might have trouble opening your eye all the way because of pain.
Not everyone experiences pain in all cases, and some people may experience only a few of these symptoms. Other potential symptoms include:

  • Flu-like feelings with body aches and tiredness that can last for several days after an outbreak (postherpetic neuralgia)
  • Pain when moving your eyes or eyebrows, as well as blurred vision or sensitivity to light (ophthalmic zoster)
  • Hearing loss or other ear symptoms (zoster auricularia)
  • Herpes Zoster ophthalmicus – Third Paragraph: The first symptom of shingles can be tingling, numbness, burning, or pain. In about two-thirds of cases, it starts on one side of your face.

Cause of Herpes Zoster Ophthalmicus

Herpes Zoster ophthalmicus (Shingles of the Eye) is caused by Herpes Zoster Virus. An acute viral infection that causes a painful rash, fever, and extreme sensitivity to light. Herpes Zoster most commonly affects people aged 50 or above but anyone can get it.

It typically follows an attack of chickenpox or may be triggered by surgery on spinal nerves, diabetes, or immunosuppressive therapy such as that used following organ transplantation.
The virus lies dormant in your body until it decides to attack again. It can lie dormant for many years without symptoms but they tend to reappear at a certain time of life such as when your immune system is weakened. Most commonly, shingles affect people above 50 years of age and very rarely children below 10 years old. About 80% of people infected with Herpes Zoster will develop shingles at some point in their lives.

doctor pointing to Herpes zoster

Effect of herpetic neuralgia on the eye

Herpes zoster (shingles) can be associated with a wide variety of eye problems, including conjunctivitis, keratitis, and corneal ulceration. In rare cases, it can lead to herpetic whitlow or a recurrence of dendritic keratitis (recurrent dendritic keratitis). Herpes zoster ophthalmicus refers to dermatomal skin lesions associated with the conjunctival injection. This entity typically affects individuals who have had prior episodes of herpetic neuralgia in their facial area.

Ocular herpetic lesions may also occur in isolation from herpetic neuralgia. Ocular herpes can manifest as a result of direct viral replication within epithelial cells of either primary or secondary infection. Herpes zoster ophthalmicus, which occurs when facial dermatomal skin lesions are associated with conjunctival injection, most commonly affects individuals who have had prior episodes of herpetic neuralgia in their facial area. Fortunately, most patients recover completely with antiviral therapy alone.


A doctor can confirm an HSV-1 infection by swabbing a lesion and sending it to a lab for analysis. However, since both forms of HSV reside in body tissue rather than on its surface (in contrast to other viruses that cause outward symptoms like cold sores or chickenpox),

it can be very difficult to tell if a person has been infected. Plus, there’s no blood test that can distinguish between strains of either virus. There are some tests that look for antibodies in saliva or urine, but they aren’t terribly reliable and won’t tell you whether you have a current infection or just an old one that has left your system.

Treatment Options for Herpes Zoster ophthalmicus

If you’ve suffered from shingles and are experiencing symptoms of eye involvement, your doctor will probably recommend treatment. Treatment usually consists of antiviral medications like acyclovir, famciclovir, or valacyclovir. These drugs can reduce inflammation and relieve pain caused by shingles in your eyes. It may take a few weeks to start working fully. Be sure to keep up with your prescribed dosage.

Another option for treatment includes corticosteroids. These medications, which include dexamethasone and prednisone, can be used to help reduce eye swelling and inflammation. They may also bring some relief from pain. In some cases, an anti-inflammatory medication like aspirin or ibuprofen can help manage your symptoms. A doctor might also prescribe antibiotics if you have a bacterial infection in your eye as a result of shingles.

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