Shingles of the eye
definition
Shingles of the eye or also Zoster ophthalmicus is caused by a reactivation of certain herpes viruses, the varicella-zoster viruses. The reactivation of the varicella-zoster infection develops in the case of shingles of the eye in the first branch of the trigeminal nerve, the Ophthalmic nerve. Therefore the symptoms arise in the forehead region and around the eyes.Typical are skin changes that usually occur on one side, severe pain and possibly loss of sensitivity in the affected area, a reduced general condition and fever.
The facial rose on the eye carries a high risk of complications. If the eyes are also affected, corneal scars can partially or completely lead to blindness of the eye. Due to the impending complications, early drug treatment is particularly important in ophthalmic zoster.
Read more on the topic: Shingles on the face
causes
Shingles of the eye is caused by the varicella zoster viruses that occur worldwide and belong to the herpes viruses. In the so-called initial infection or primary infection, the virus causes chickenpox. Once the disease has healed, the virus remains in certain nerve cell clusters, so-called, for life Ganglia.
A temporary immune deficiency, triggered for example by stress, tumor diseases, infectious diseases or immunosuppressants, can reactivate the virus and thus lead to shingles in the eye and face area. It is only possible to get shingles if there has been contact with the virus in the form of a chickenpox infection or a varicella vaccination.
Read more on the topic: Vaccination against chickenpox, chickenpox in adults
diagnosis
As a rule, shingles of the eye is diagnosed through a detailed anamnesis and the clinical appearance. If there is uncertainty about the clinical diagnosis or if the course of the disease is complicated, a pathogen detection can also be carried out in the laboratory. As a rule, however, this is not necessary, as the clinical findings are clear from the typical skin changes in certain areas, the general symptoms and medical history.
Concomitant symptoms
Shingles on the eye usually leads to a typical course of the disease. It usually begins with a burning sensation and severe pain in the area supplied by the affected nerve. The forehead, bridge of the nose and tip of the nose are particularly affected. It is also possible that in these areas there is reduced sensitivity of the skin and, if the eye is affected, the cornea as well. Usually these symptoms appear a few days before the typical skin changes appear.
Often the patients also suffer from a deteriorated general condition, tiredness, exhaustion and possibly have a fever. If the eye is also affected, it can lead to conjunctivitis, corneal inflammation, inflammation of the iris in the eye or inflammation of the optic nerves. And so, at the beginning of ophthalmic zoster, photophobia, increased tearing, reddening and swelling of the eye can occur.
Later, small vesicles and pustules appear in groups, which are painful, itchy and, as the disease progresses, burst and crust yellowish-brown. The vesicle formation takes two to three days, the contents of the vesicles are highly infectious.
Read more on the topic:
- Shingles incubation period
- How contagious is shingles
- Herpes zoster oticus
Swelling of the eye
As a further symptom, ophthalmic zoster can lead to swelling in the area of the eyes - especially in the area of the eyelids. Similar to the formation of blisters, swelling usually only occurs on one side. In addition, the infectious contents of the vesicles (blisters) can cause inflammation of the conjunctiva.
Read more on the topic: Puffy eyes - what's behind it, what helps?
Eye pain
If eye involvement occurs as part of ophthalmic herpes zoster, eye pain can occur. These arise because the inflammation of the anterior eye area can block the corner of the chamber, which is normally responsible for the drainage of eye water.
If this is not possible, the intraocular pressure increases, which can lead to eye pain due to pressure on the optic nerves. Furthermore, eye pain can arise through the involvement of all structures of the eye, such as the conjunctiva or cornea, which can also lead to pain.
Watery eye
If the eye and especially the eyelids are involved, the tear ducts (see also: Inflamed tear duct) come. These swell as a result and the tear fluid can no longer be drained towards the nose. An uncontrollably watery eye follows.
Usually this is only limited to the duration of the illness. However, if there is a scarred healing of the tear ducts, they can be permanently narrowed, which makes the condition of the watery eye permanent. In some cases, this can be remedied by a small surgical procedure.
You might also be interested in the following topic: Tear duct disorder
Red eye
A reddened eye occurs mainly when the conjunctiva is involved, which is the case in up to 90% of ophthalmic herpes zoster. In addition to the increased vascular markings, there are small hemorrhages (Petechiae) to recognize. In addition, eyelid swelling and increased tear production are usually found.
Burning pain
The outbreak of a herpes zoster on the face is preceded by a preliminary stage lasting several days. At this stage it occurs in the affected area Dermatome, i.e. the skin area that is supplied by the affected nerve fibers, leads to phased or permanent burning, itching, numbness and pain. The appearance of these symptoms can lead to incorrect suspected diagnoses, since at this point in time there are no skin changes typical of shingles and the diagnosis of zoster ophthalmicus cannot yet be made.
Read more on the topic:
- Facial pain
- Skin burns
- Shingles pain
Treatment / therapy
The aim of treatment is to bring about rapid pain relief and reduction in skin lesions. Attempts are made to keep the risk of infection and spread of the pathogen as low as possible. Another very important goal is to prevent or alleviate complications such as post-zoster neuralgia. This is severe and persistent pain in the affected skin area, which persists beyond the shingles disease.
The treatment of shingles of the eye consists of systemic therapy with the virus-inhibiting drug acyclovir. In addition, painkillers ranging from paracetamol to light opioids are used, depending on the pain intensity. Good pain medication is important to avoid possible complications like the above. Prevent post-herpetic neuralgia.
The vesicles can be treated locally to dry out and become anti-inflammatory.
Read more on the topic: Zinc ointment
If the eye or cornea are also affected, certain topical virus-inhibiting ointments or eye drops are used.
Antiviral therapy is always urgently needed for shingles in the head and neck area and if it is started in time, the course of the disease can be shortened, the healing process accelerated and the complication rate reduced.
Read more on the topic: Shingles on the head - you should definitely pay attention to this!
Home remedies
Shingles with involvement of the eye can lead to very serious complications, even with intensive therapy. It is therefore generally not advisable to treat this form of shingles yourself with home remedies. It can only be advised in the sense of hygiene precautions to wash all towels and washcloths used with hot water.
In addition, direct sunlight and computer work should be avoided. In any case, however, medically guided drug therapy should take place.
Duration
As a rule, the burning and painful preliminary stage of the skin areas lasts two to three days before the first blisters form. The blistering phase takes another two to three days before they burst, dry out and form yellowish-brown crusts. The zoster ophthalmicus heals within two to three weeks.
Read more on the topic: How long does shingles last?
Complications
If an infection with varicella zoster virus occurs in the area of the eyes, there is a risk that these can reach the optic nerves via the trigeminal nerve. In the worst case, this can lead to long-term damage to the cornea with resulting deteriorated vision (also known as Decreased vision labeled) up to blindness of the eye.
Read more on the topic: Inflammation of the trigeminal nerve
Post-herpetic neuralgia should be listed as a further complication. This is severe pain in the affected areas that occurs beyond the shingles disease.
Read more on the topic: Shingles in Pregnancy - It's That Dangerous!
How contagious is shingles of the eye?
The risk of infection in the case of shingles of the eye comes exclusively from the contents of the filled blisters. This is the big difference to the transmission of chickenpox. Although these are caused by the same pathogen, they are much more contagious because chickenpox can also become infected via the air, i.e. airborne. In the case of shingles, it is sufficient to leave the affected area alone, to treat locally anti-inflammatory or antiseptic and to avoid scratching, etc.
Read more on the topic: How contagious is shingles
Shingles on the eyelid
If the eyelid is affected by shingles, it is called a so-called Herpes zoster ophthalmicus. Since the entire ophthalmic nerve is affected, the skin of the forehead or other parts of the eye, such as the cornea or the conjunctiva, can be affected in addition to the eyelid.
Basically, the upper and lower eyelids can be affected. They then show severe swelling with reddening. Shingles usually affects only one half of the face. The eyelids are usually affected very early in ophthalmic herpes zoster. Numerous complications can arise from involvement of the eyelids.
In addition to the death of certain areas of the skin, so-called necrosis, these include malocclusions due to cicatricial healing. Rarely, the tear ducts can also be affected, which are narrowed and lead to increased tear flow.
Shingles under the eye
If the shingles affects the skin area under the eye, the second nerve branch is usuallyMaxillary nerve) of the trigeminal nerve affected. One speaks here of one Herpes zoster maxillary. In addition to the usual skin changes, this can also spread to the bones and lead to the death of bone areas. One speaks here of osteonecrosis.
These can be accompanied by the loss of several teeth and usually require surgical intervention. Involvement of the nose, here especially the tip, in turn indicates a sub-form of the Herpes zoster ophthalmicus down (so-called. Hutchinson sign). This indicates involvement of the eye, which can be associated with serious complications such as retinal death and loss of vision.
Shingles on the eyebrow
The facial rose in the eye, ophthalmic zoster, particularly affects the forehead, bridge of the nose, tip of the nose and eyes because of the innervation area of the affected nerve. In these areas, the typical zoster skin symptoms, pain, burning and itching occur. The zoster usually occurs on one side and affects one to three dermatomes. This is the name given to areas of skin that are sensitively supplied by nerve fibers from different spinal cord segments. Therefore, the eyebrow can be affected by the zoster on the eye.
Read more on the topic: Pain in the eyebrow
