Shingles outbreak near the eye requires immediate attention
Q: A couple of months ago, my wife had shingles. The rash spread to her face, near her eye. This went away without treatment, but the doctor said it could return. If it comes back, does this pose any special danger?
A: It sure does. Beyond the pain and discomfort that shingles can cause anywhere in the body, when it gets near the eye it can threaten eyesight.
Shingles is caused by the varicella-zoster virus (VZV). This is the same virus that causes chickenpox. Once you have had chickenpox, VZV quietly remains in your body's nerve tissues and never really goes away. It is inactive, but it can be reactivated later in life. This causes shingles.
When the virus reactivates, it creates a burning or tingling sensation in the affected areas. A few days later, the virus causes a blistery rash. The blisters may be painful or itchy. The skin may be extremely sensitive, so much so that you may not be able to stand clothing touching or rubbing the area. Blisters continue to appear over two to seven days before they break, form crusts and then heal.
Fortunately, shingles doesn't often occur on the face, but it can. And when it occurs on the upper half of the face and head, near the eye, complications can be serious and can lead to loss of vision.
One possible complication that can affect the eye is inflammation, which makes the eye painful and sensitive. Discomfort may extend to the forehead or the top of the head. These symptoms may be accompanied by fever, headache, decreased vision or a droopy eyelid.
Another possible eye complication is inflammation and damage of the retina. The retina, located in the back of the eye, sends visual images to the brain via the optic nerve. Symptoms of an inflamed retina include blurry vision and pain. The condition may begin in one eye, but often spreads to the other eye.
Your wife's shingles can return again. If she develops any strange rash on her face, particularly little blisters, she should contact her doctor immediately. If she develops strange, unpleasant sensations on her upper face, forehead or the top of her head — even if there is no rash — she also should contact her doctor immediately. She should be promptly treated with anti-viral medicines, possibly into the veins rather than as pills.
And if your wife experiences any of the eye symptoms I mentioned, she should see an eye specialist (ophthalmologist) that day. In addition to the anti-viral medicines, the eye doctor may add anti-inflammatory eye drops.
Once your wife has recovered, she should get the Zostavax shingles vaccine. It will help prevent a recurrence of shingles.
Fortunately, shingles does not take a person's vision very often — but it can. The most important thing is not to delay getting medical attention. Shingles near the eye is a medical emergency. To delay getting care and treatment by even a day can lead to big trouble.
• Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.