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Shingles is the term we use to describe a condition that is caused by a re-activation of the Herpes Varicella-Zoster virus. The origin of this infection usually goes way back to childhood with a disease we know as chickenpox.
When you have a chickenpox infection your immune system manages to eventually suppress that virus from causing an active infection, but the virus does not get completely eliminated from your body--it is able to go and hide in your nerve roots.
Your immune system manages to keep the virus in check for most of your life but there may come a time in adulthood when your immune system is not working as well as it used to, and the virus can reappear. It usually does this along the distribution of a single sensory nerve called a dermatome.
The most common area for this to occur is along your trunk (chest or abdomen) but it is also commonly found on the face.
There are three branches of nerves that supply sensation to your face. They are all branches of the fifth cranial nerve. Those three branches supply the upper face (V1), the mid face (V2), and the lower face (V3). Most of the time, shingles breaks out along only one of the branches at a time. The one that most frequently involves the eye is a rash breakout in the V1 distribution. This can involve the forehead and both the upper and lower eyelid. It is also much more likely that the inside of the eye will be involved if the tip of the nose has a lesion on it. The reason for that is that there is a specific subbranch of the V1 nerve called the nasocilliary nerve. This nerve is responsible for sensation on the tip of the nose and the inside of the eye.
The hallmark of shingles is that once the rash erupts it stays on one side of the body, including when it happens on the face. The rash will go up to the centerline of your face but will not go to the other side. You may get lesions on your scalp, but they will not show up on the back of your head. That is because the V1 does not go past half way back on your scalp. The back of your head has its sensation handled by nerves that come out of your spinal cord not cranial nerves that come out of the front of your skull.
Many people have a hard-to-describe sensation of pain, irritation, or itching along the distribution of the nerve for a day or two before the rash shows up. It is important to recognize the rash as quickly as possible because the drugs that treat shingles--usually Acyclovir, Famvir (famciclovir), or Valtrex (valacyclovir)--are much more effective if they are started within three days of the beginning of the rash.
Eye problems may occur along with the rash, especially if there is a lesion on the tip of the nose.
The two biggest problems are swelling or inflammation of the cornea and inflammation inside the eye, which we call iritis or uveitis.
The inflammation in the eye can cause pain and it can also increase eye pressure and cause glaucoma. Most often the treatment for the eye problem is to use the same oral medication mentioned above and sometimes it also can require eye drops to decrease the inflammation the virus is causing (steroid drops) or drops to try and lower the elevated pressure (glaucoma drops).
The eye inflammation can cause blurred vision, pain, and significant light sensitivity. It can be hard to treat and control and can continue to be a problem long after the skin lesions are gone. In fact, many times problems don’t even start until the skin lesions are starting to go away.
It is recommended that if you have shingles affecting the distribution of V1, you should have an eye exam within a few days of the diagnosis being made and then another exam again a week later because, as mentioned above, the eye problems can present a week later than the skin eruptions.
There can be some serious long-term effects of shingles on your eye, including glaucoma and corneal scarring that can be bad enough to require a corneal transplant. The symptoms are often obvious with the vision being blurry and the eye being very red and painful, but sometimes the symptoms may be much more mild even when significant trouble is brewing inside the eye. So even if you think the eye feels fine, you need an exam to ensure there is not subtle inflammation or significant elevation of the pressure in the eye.
The other long-term problem with shingles around the eye is the possibility of there being ongoing pain in the area that can last for many years. This is called Post Herpetic Neuralgia (PHN). This pain can occur all along the dermatome where shingles had occurred. The eye itself may look perfectly normal but the pain persists. This is often treated with drugs that were originally developed as seizure medication but have since been shown to help alleviate neurological pain. The two most commonly used drugs for this are Neurontin (Gabapentin) and Lyrica (Pregabalin).
The most important thing you can do to try and make sure this doesn’t happen to you is to be vaccinated for shingles. The original vaccination called Zostavax has been available since 2006 in the U.S. It is a single-injection vaccine and was recommend for everyone over 60. The main issue with this vaccine is that it only reduced the risk of getting shingles by 51% and PHN by 67%. In 2017 a new vaccine was approved in the U.S. called Shingrix. This vaccine is a two-injection vaccine with the second shot given 2 to 6 months after the first. This vaccine is recommended for everyone 50 years or older. The big advantage of this vaccine is that is 85-97% effective in preventing both shingles and PHN in people with normal immune systems. For more information about this vaccine you can go to the CDC website by clicking here.
Article contributed by Dr. Brian Wnorowski, M.D.
This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.
“I want an official Red Ryder, carbine action, two-hundred shot range model air rifle!”
“No, you'll shoot your eye out.”
This line from “A Christmas Story” is one of the most memorable Christmas movie quotes ever. Funny in the movie, but the holiday season does present a real eye injury threat.
For those who celebrate Christmas, that risk begins even before the actual day.
Some of the most frequent holiday-related eye injuries come from the Christmas tree itself.
Holiday eye safety begins with the acquisition of the tree. If you are cutting down your own tree, please wear eye protection when doing the cutting--especially if you are going to be using a mechanical saw, such as a chain saw or sawzall. You need to also be careful of your eyes when loading a tree on top of the car. It is easy to get poked in the eye when heaving the tree up over your head.
Once back at home, take care to make sure no one else is standing close to the tree if you had it wrapped and now need to cut the netting off. The tree branches often spring out suddenly once the netting is released.
Other injuries occur in the mounting and decorating phase. Sharp needles, pointy lights, and glass ornaments all pose significant eye injury risk. If you are spraying anything like artificial tree snow on the branches be sure to keep those chemicals out of your eyes.
Having now successfully trimmed the tree without injury, let’s move our holiday eye safety talk to the toys.
We want to spend the holiday happily exchanging gifts in front of a warm fire, drinking some eggnog, and snacking on cookies--not going to the emergency room with an injury.
The Consumer Product Safety Commission reported there were 254,200 toy-related emergency room visits in 2015, with 45% of those being injuries to the head and face--including the eyes.
In general, here are the recommendations from the American Academy of Ophthalmology in choosing eye-safe toys for gifts:
- “Avoid purchasing toys with sharp, protruding or projectile parts."
- “Make sure children have appropriate supervision when playing with potentially hazardous toys or games that could cause an eye injury."
- “Ensure that laser product labels include a statement that the device complies with 21 CFR (the Code of Federal Regulations) Subchapter J."
- “Along with sports equipment, give children the appropriate protective eyewear with polycarbonate lenses. Check with your eye doctor to learn about protective gear recommended for your child's sport."
- “Check labels for age recommendations and be sure to select gifts that are appropriate for a child's age and maturity."
- “Keep toys that are made for older children away from younger children."
- “If your child experiences an eye injury from a toy, seek immediate medical attention.”
More specifically, there is a yearly list of the most dangerous toys of the season put out by the people at W.A.T.C.H. (world against toys causing harm).
Here are types of toys to avoid:
- Guns that shoot ANY type of projectile. This includes toy guns that shoot lightweight, cushy darts.
- Water balloon launchers and water guns. Water balloons fired from a launcher can easily hit the eye with enough force to cause a serious eye injury. Water guns that generate a forceful stream of water can also cause significant injury, especially when shot from close range.
- Aerosol string. If it hits the eye it can cause chemical conjunctivitis, a painful irritation of the eye.
- Toy fishing poles. It is easy to poke the eyes of nearby children.
- Laser pointers and bright flashlights. The laser or other bright lights, if shined in the eyes for a long enough time, can cause permanent retinal damage.
There are plenty of great toys and games out there that pose much lower risk of injury so choose wisely, practice good Christmas eye safety, and have a great holiday season!
Article contributed by Dr. Brian Wnorowski, M.D.
This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.
