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Herpes Zoster Ophthalmicus

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

By Melvin I. Roat, MD, FACS

Herpes zoster ophthalmicus is infection of the eye caused by varicella-zoster virus.

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 and may spread to the skin, causing herpes zoster, also called shingles (see page Shingles). If the forehead or nose becomes infected, the eye also becomes infected in about half of people, on the same side as the skin involvement.

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 pain, redness, light sensitivity, and eyelid swelling. 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 can lead to injuries. The appearance of active shingles, a history of the typical rash, or old scars from a shingles rash help a doctor make the diagnosis.

As with shingles anywhere in the body, early treatment with an antiviral drug such as acyclovir, valacyclovir, or famciclovir (which are taken by mouth) can reduce the duration of the painful rash. When herpes zoster infects the face and threatens the eye, treatment with an antiviral drug reduces the risk of eye complications. Corticosteroids, usually in eye drops, may also be needed if the eye is inflamed. Eye drops, such as atropine, are used to keep the pupil dilated, to help prevent a severe form of glaucoma, and to relieve pain.

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