Summary about Disease
Zoster ophthalmicus (ZO) is a reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox. In ZO, the virus affects the ophthalmic branch of the trigeminal nerve, leading to shingles involving the eye and surrounding structures. This can result in a painful rash, potential vision loss, and other serious complications.
Symptoms
Early Symptoms: Headache, fever, malaise, tingling, burning, or itching sensation on the forehead and around the eye.
Skin Rash: Typically appears 2-3 days after the initial symptoms. It starts as small, red bumps that turn into fluid-filled blisters (vesicles). The rash usually affects one side of the forehead, scalp, upper eyelid, and sometimes the tip or side of the nose (Hutchinson's sign).
Eye Involvement: Redness, pain, swelling of the eyelids, conjunctivitis, keratitis (inflammation of the cornea), uveitis (inflammation inside the eye), glaucoma, and optic nerve damage.
Other Symptoms: Sensitivity to light (photophobia), blurred vision, decreased corneal sensation, drooping eyelid (ptosis).
Causes
ZO is caused by the reactivation of the varicella-zoster virus (VZV). After a person has chickenpox, the virus remains dormant in nerve cells. It can reactivate years later, typically due to a weakened immune system (caused by factors like age, stress, illness, or certain medications). The reactivated virus travels along the nerve fibers to the skin, causing shingles. When the ophthalmic branch of the trigeminal nerve is affected, it results in Zoster ophthalmicus.
Medicine Used
Antiviral Medications: Acyclovir, valacyclovir, and famciclovir are the primary treatments. They help to reduce the severity and duration of the outbreak and prevent complications. These medications are most effective when started within 72 hours of the rash appearing.
Pain Relief: Analgesics (over-the-counter or prescription) can help manage the pain. Topical treatments like capsaicin cream might be used after the rash has healed.
Steroid Eye Drops: Used to reduce inflammation inside the eye (uveitis or keratitis).
Pupil-Dilating Drops: To prevent the pupil from sticking to the lens in cases of uveitis.
Glaucoma Medications: If glaucoma develops as a complication, medication to lower eye pressure will be prescribed.
Antibiotic Ointment: If the blisters become infected, antibiotic ointments may be used.
Is Communicable
ZO itself is not communicable. However, the varicella-zoster virus (VZV) *is* communicable. A person with ZO can spread VZV to someone who has never had chickenpox or been vaccinated against it. This spread occurs through direct contact with the fluid from the blisters. If infected, the person will develop chickenpox, not shingles. Once the blisters have crusted over, the person is no longer contagious.
Precautions
Avoid Contact: Keep the rash covered to prevent spreading the virus. Avoid close contact with pregnant women who have never had chickenpox or the vaccine, premature infants, and people with weakened immune systems.
Hygiene: Wash hands frequently with soap and water, especially after touching the rash.
Avoid Sharing: Do not share towels, clothing, or bedding with others.
Stay Home: Avoid going to work or school until the blisters have crusted over.
Vaccination: The shingles vaccine (Shingrix) can significantly reduce the risk of developing shingles and postherpetic neuralgia.
How long does an outbreak last?
The duration of a Zoster ophthalmicus outbreak varies, but generally follows this timeline:
Prodromal phase: 1-4 days of pain, tingling, or itching before the rash appears.
Active rash phase: 2-4 weeks, during which blisters develop, rupture, and crust over.
Postherpetic neuralgia (PHN): Pain can persist for months or even years after the rash has healed. The entire outbreak, including PHN, can last from several weeks to many months. Early treatment with antiviral medications can shorten the duration and reduce the risk of complications.
How is it diagnosed?
Diagnosis is usually made based on:
Medical History: History of chickenpox or shingles.
Physical Examination: Characteristic rash distribution along the ophthalmic branch of the trigeminal nerve. Hutchinson's sign is a key indicator.
Eye Exam: A thorough eye examination by an ophthalmologist to assess for corneal involvement, uveitis, glaucoma, or optic nerve damage.
Laboratory Tests (less common): In atypical cases, tests like viral culture, PCR (polymerase chain reaction) testing of blister fluid, or direct fluorescent antibody (DFA) staining can confirm the presence of VZV.
Timeline of Symptoms
Days 1-4: Prodromal symptoms (pain, tingling, burning, itching, headache, fever, malaise).
Days 2-7: Rash appears as red bumps, quickly turning into fluid-filled blisters.
Days 7-14: Blisters rupture and begin to crust over. Pain is often most intense during this phase.
Weeks 2-4: Crusts fall off, and the skin begins to heal.
Following Weeks/Months: Postherpetic neuralgia (PHN) may develop and persist. Ocular complications, if they occur, might require ongoing management.
Important Considerations
Early Treatment is Crucial: Antiviral medications are most effective when started within 72 hours of the rash appearing.
Ophthalmological Consultation: Immediate consultation with an ophthalmologist is essential to assess and manage eye involvement.
Postherpetic Neuralgia (PHN): This is a common and debilitating complication. Pain management strategies are crucial if PHN develops.
Vision Loss: ZO can lead to permanent vision loss if not treated promptly and appropriately.
Shingles Vaccine: Vaccination significantly reduces the risk of developing shingles and its complications, including ZO and PHN. Anyone over 50 should talk to their doctor about getting the shingles vaccine.