Herpes Zoster Ophthalmicus

(Herpes Zoster Virus Ophthalmicus; Ophthalmic Herpes Zoster; Varicella-Zoster Virus Ophthalmicus)

ByMelvin I. Roat, MD, FACS, Sidney Kimmel Medical College at Thomas Jefferson University
Reviewed/Revised Aug 2022 | Modified Jan 2023

Herpes zoster ophthalmicus is a reactivated infection of the eye caused by the varicella-zoster virus, the virus that causes chickenpox and shingles.

  • Symptoms include pain and tingling of the forehead, blisters on the forehead and nose, eye ache and redness, light sensitivity, and eyelid swelling.

  • Doctors diagnose herpes zoster ophthalmicus based on evidence of a shingles rash and involvement of the eye.

  • The shingles vaccine can help prevent reactivation of the varicella-zoster virus.

  • People with herpes zoster ophthalmicus are treated with antiviral drugs.

Varicella-zoster is the virus that causes chickenpox. Once people are infected, the virus remains in a dormant (inactive) stage in the nerve roots. In some people, the virus reactivates because of waning immunity with aging and may spread to the skin, causing herpes zoster, also called shingles. If the virus affects the forehead or nose, the eye also can become infected in about half of people, on the same side as the affected skin.

Symptoms of Herpes Zoster Ophthalmicus

Pain or tingling of the forehead may occur before any other symptoms (called a prodrome).

The skin of the forehead and sometimes the tip of the nose are covered with small, extremely painful, red blisters.

Infection of the eye causes ache, redness, light sensitivity, and eyelid swelling. The cornea (the clear layer in front of the iris and pupil) can get infected and inflamed. Months and years later, the cornea can become swollen, severely damaged, and scarred. The structures behind the cornea can become inflamed (uveitis), the pressure in the eye can increase (glaucoma), and the cornea can become numb, which leaves it vulnerable to injuries.

An Inside Look at the Eye

Diagnosis of Herpes Zoster Ophthalmicus

  • A doctor's evaluation

The appearance of active shingles, a history of the typical rash, or old scars resulting from a previous shingles rash help a doctor make the diagnosis of shingles.

Prevention of Herpes Zoster Ophthalmicus

A recombinant shingles vaccine is recommended for healthy people aged 50 or over, regardless of whether they have had chickenpox or shingles or been given the older herpes zoster vaccine. The recombinant vaccine is effective in more than 90% of people, whereas the older vaccine was effective in 50% of people.

Treatment of Herpes Zoster Ophthalmicus

  • Antiviral drugs taken by mouth

  • Corticosteroid eye drops

  • Eye drops to keep the pupil dilated

Corticosteroids, usually in eye drops, may also be needed if the eye is inflamed.

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