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  Herpes zoster ophthalmicus is infection of the eye caused by varicella-zoster virus.
  If the forehead or nose becomes infected, the eye is also likely to become infected, on the same side as the skin involvement.
  Source: Herpes Zoster Ophthalmicus: Corneal Disorders: Merck Manual Home Edition (merck.com)
  

Epidemiology

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  Estimated annual incidence of herpes zoster in the United States was at least 500,000 cases.
  In the era of VZV vaccination, the incidence of primary infection has been reduced by as much as 90%.
  In the US: High-risk groups, such as elderly populations and immunocompromised people, may experience cumulative incidences as great as 50%.
  People of all ages can be affected, but incidence increases with age, presumably through the general decrease in immune function that occurs with aging.
  No significant sex predominance has been observed in herpes zoster.
  Long-term complications of ophthalmic zoster with corneal involvement occur in over 20% of such patients and may result in blindness
  
  Source: eMedicine - Herpes Zoster : Article by James E Moon, MD (emedicine.com)
  

Prevention

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  Prevention is uncertain.
  Avoid contact with the skin lesions of persons with known herpes zoster infection (shingles or chickenpox), if you have never had chickenpox or the chickenpox vaccine, or ESPECIALLY if your immune system is compromised.
  The chickenpox vaccine (varicella) is a recommended childhood vaccine. The vaccine may be recommended for teenagers or adults who have never had chickenpox or the vaccine.
  Source: AllRefer Health - Herpes Zoster Prevention (Shingles) (health.allrefer.com)
  

Symptoms

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  The skin manifestations of herpes zoster ophthalmicus strictly obey the midline. A vast majority of patients will have vesicular lesions on the eyelids that resolve with minimal scarring.
  Patients may develop blepharitis and present with ptosis secondary to edema and inflammation.
  Most patients with herpes zoster ophthalmicus present with a periorbital vesicular rash distributed according to the affected dermatome.
  A minority of patients may also develop conjunctivitis, keratitis, uveitis, and ocular cranial-nerve palsies.
  Permanent sequelae of ophthalmic zoster infection may include chronic ocular inflammation, loss of vision, and debilitating pain.
  Source: Evaluation and Management of Herpes Zoster Ophthalmicus - November 1, 2002 - American Family Physician (aafp.org)
  

Diagnosis

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  The diagnosis is usually clinical, based on typical lesions in a single dermatome. Various techniques to detect the virus or antibody detection may be possible after consultation with a microbiologist. Tzanck smears may yield results but scraping for smears and cultures are usually negative.
  Source: Ophthalmic Shingles - Patient UK (patient.co.uk)
  

Treatment

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  When herpes zoster infects the face and threatens the eye, early treatment with acyclovir, which are taken by mouth, reduces the risk of eye complications.
  Corticosteroids, usually in eye drops, may also help. Eye drops, such as atropine, are used to keep the pupil dilated, to help prevent a severe form of glaucoma, and to relieve pain.
  Source: Herpes Zoster Ophthalmicus: Corneal Disorders: Merck Manual Home Edition (merck.com)
  

Illustrations

Information for specialists

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  Ocular Palsies in Ophthalmic Zoster Jocelyn Zurevinsky, O.C.(C.) Of all ophthalmic zoster cases, seven to 31% involve the nerves supplying the extra ocular muscles, the third nerve being the most often affected. Some believe muscle palsies may not develop until as late as two years after the rash. Many dispute the chance of full recovery of muscle function. We present four patients with zoster who developed ocular palsies. Two had third nerve and sixth nerve involvement. One had only third nerve involvement and the fourth had only sixth nerve involvement. One patient developed paresis four weeks after onset of the rash. Two recovered fully.
  Source: AOJ 43:130-134 "Ocular Palsies in Ophthalmic Zoster" (aoj.org)
  

Association

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  American Chronic Pain Association
  Source: American Chronic Pain Association (theacpa.org)
  

Scientific articles: All recent articles for "Herpes Zoster Ophthalmicus"

Clinical trials for "Herpes Zoster Ophthalmicus":

• Herpetic Eye Disease Study (HEDS) I
• Herpetic Eye Disease Study (HEDS) II