Herpes Zoster Ophthalmicus

“Little things make big things happen” – John Wooden.

At 120 – 300 nanometers (0.00012 to 0.0003 millimeters), you would definitely call the Herpes Zoster Virion anything but big. But the amount of havoc this tiny little virus can cause has to be seen to be believed!

What is Herpes Zoster Ophthalmicus?

Herpes Zoster Ophthalmicus is an eye disease that is caused by the varicella zoster virus affecting a nerve called the trigeminal nerve.  Herpes Zoster Ophthalmicus is seen in about 10 to 25% of all people who have been affected with shingles.

 

 

What causes Herpes Zoster Ophthalmicus?

The Varicella Zoster Virus is the same virus that causes chicken pox. After this infection has settled down, the virus remains inactive silently in your body for years. Later as your body’s immune system weakens either due to aging (above 60 years), stress, or any illness / treatment that suppresses your immunity, this virus gets reactivated. This now causes shingles or herpes zoster which can affect your trigeminal nerve.

Do I have Herpes Zoster Ophthalmicus? (Signs and Symptoms)

Initial Phase: In this stage, you may suffer from flu-like symptoms: Low grade fever, tiredness, feeling of general discomfort and headache. This may last for a week.
Pain in the eyes may be accompanied with pain in the forehead, eyelid or nose.
Excess watering of your eyes
Decrease in vision
Redness of eyes
A rash which may be red, fluid-filled or pus-filled can be seen on one side over your forehead, upper eyelid and nose.
 

What are the tests for Herpes Zoster Ophthalmicus?

External examination of eyelids, skin around your eyes and scalp
Slit lamp Examination
Visual Acuity testing
Eye Pressure Testing

Cells may be scraped from the skin rashes and sent for microscopic examination
Viral cultures and Polymerase chain reaction testing may rarely be required.
A dye called fluorescein may be put into your eyes to examine your cornea under ultra violet light.

 

 

What are the complications of Herpes Zoster Ophthalmicus?

• Swelling of your conjunctiva (clear, outermost covering of your eye) and tissues around your eye
• Infection with bacteria (especially one called Staphylococcus Aureus) which can cause scarring
• Scarring can lead to you having difficulty closing your eyelid completely (ptosis) which further causes drying up of your cornea (clear front surface of your eye)
• Scarring can also lead to entropion (in-turning of eyelid) or ectropion (outward rolling of your eyelid).
• Inflammation (reaction of your body marked by redness, swelling etc.) of cornea which can go on to develop erosions and ulcers
• Your iris (the coloured part of your eye) can get inflamed and scarred leading to glaucoma and cataract.
• Apart from this, your herpes can spread to other parts of your body.
• Post herpetic neuralgia is a condition where pain persists even after the herpes lesions have settled.

 

How is Herpes Zoster Ophthalmicus treated?

Anti-viral medications

Steroid Eye Drops: These should be used only as prescribed by your doctor

Oral medications may be required for the severe pain that herpes causes

Corneal Transplantation Surgery may be required in situations where damage occurs to your cornea.

Vitrectomy or Retinal detachment Surgery may be required at times

Glaucoma Filtration Surgery may be needed if the pressure inside the eye is raised.