I turned 50 during the pandemic and, like most people, I put off all nonessential health care, including my shingles vaccine. Big mistake. When the telltale red bumps of shingles cropped up on my face in the fall of 2020, it triggered a cascade of health effects that still haunt me four years later.
Nearly one in three people in the U.S. gets shingles, a recurrence of the herpes zoster virus, or chickenpox, every year. Of those, about 20% get ocular shingles, or shingles in the eye, which can last “days to weeks to years,” even with treatment, according to Michelle Andreoli, clinical assistant professor of ophthalmology at Northwestern Feinberg School of Medicine and a spokesperson for the American Academy of Ophthalmology.
“The complications of herpes zoster can be severe and even lead to blindness,” Andreoli says. Recent findings have linked the shingles virus itself with an increased long-term risk of heart disease and stroke, according to research in the journal Clinical Infectious Disease, as well as an increased risk of cognitive decline, according to a study in the journal Alzheimer’s Research & Therapy.
Since there’s no cure for shingles in the eye, also called herpes zoster ophthalmicus or zoster keratitis, the best way to protect yourself is to get a vaccine before you develop it.
Here’s what you need to know about shingles on the face and in the eye, how to recognize the signs and the best way to protect yourself.
[Read: How Aging Affects Your Immune System.]
What Is Shingles and How Do You Get It?
Shingles is an infection caused by the reactivation of the herpes zoster virus, the same virus that causes chickenpox. It can get reactivated for a number of reasons, including aging (half of cases are in people 60 or older) or anything that weakens the immune system, such as HIV, chemotherapy or radiation therapy, or even extreme stress.
Shingles typically start with tingly, prickly skin (I felt like I was getting a tattoo on my forehead) and develop into a painful, itchy red rash with fluid-filled blisters and scabs within one to five days. Mine looked like angry acne at first, but I noticed that it appeared only on the right side of my face — that one-sidedness is a telltale sign of shingles.
The rash typically causes burning, shooting pain, itching and numbness, and some people get flu-like symptoms, including chills, fever, headache or stomach upset.
[Read: Why You Should Get the Shingles Vaccine Soon.]
What Happens When You Get Shingles on Your Face?
It’s unclear how many people who get shingles on their forehead, nose or cheek go on to get it in their eye, but it may be over 50%, says Elisabeth Cohen, professor of ophthalmology at NYU Grossman Medical School.
“The nerve that supplies the face, especially the forehead and tip of the nose, also supplies the eye, as part of the trigeminal nerve or cranial nerve,” Cohen explains. “When the virus goes from nerve to skin, it can also go to the eye.”
Signs you may be developing ocular shingles, according to Cohen:
— Redness on the eyelid or in the eye (conjunctivitis or pink eye)
— Dry eye or eye pain
— Blurry vision from uveitis or iritis (inflammation of the cornea)
— Light sensitivity
— Numbness from nerve damage
[Does Medicare Cover the Shingles Vaccine?]
What’s the Treatment for Shingles in the Eye?
After a shingles rash appears, it takes about two to four weeks to know if the eye is involved, Cohen says. So, if you get the rash or related pain near or on your face, have your eye checked within a month by an ophthalmologist.
Treatment depends on individual symptoms and severity and mainly focuses on resolving the rash, swelling and pain. It typically includes seven to 10 days of oral antivirals, steroid eye drops, topical ointment and cool, moist compresses.
“You want to treat the eye immediately if it’s affected to minimize complications that can result in scarring and loss of vision,” she adds.
Research has shown that treatment within 72 hours of rash onset lowers the odds of developing complications, including eye disorders, from 50% down to 20 to 30%.
My treatment was delayed for weeks as my ophthalmologist initially blamed my eye irritation on “shingles-related dry eye.” By the time I got a second opinion, my eye was speckled with dead cornea cells, and I needed to see a cornea specialist for treatment.
[READ: Is Shingles Contagious?]
How Long Do Ocular Shingles Last?
Ocular shingles can last three to five weeks, but the effects can linger for years.
“Even with optimal therapy, the zoster (virus) can be difficult to control in the eye and can have a relapsing course,” Andreoli says. “Therapy is often continually adjusted to deal with the long-term complications.”
Ongoing symptoms can include:
— Flare-ups, which cause redness, swelling, dry eye and blurry vision
— Glaucoma
— Cataracts
— Double vision
— Retinal detachment
— Chronic eye pain
— Eye scarring
— Loss of vision from scarring related to inflammation or steroid drops
Just as any shingles infection can cause post-herpetic neuralgia (excruciating pain that lingers for months or years after the rash clears), ocular shingles can also cause chronic pain and sensitivity in and around the eye.
“The nerve pain you get from shingles will be localized to the area where you had a rash,” Cohen says. “And it can last forever.”
Cohen herself had ocular shingles and developed complications in her retina as well as macular problems she believes are related to the original infection.
She recently concluded a study, pending publication, showing that people who had a shingles rash with active eye inflammation developed 50% fewer complications (including new or worsening inflammation and pain) after taking high-dose antiviral medication for 18 months compared to people who took the medication for 12 months or not at all.
I’ve been taking anti-viral medication daily for four years now, along with steroid drops, to control my flare-ups. It’s led to a cataract that cause me to see halos around lights at night. I’m also aware of blurry vision when I’m tired. My ophthalmologist says I’ll need to treat it down the line with cataract surgery.
Who Should Get the Shingles Vaccine?
Since there’s no cure for the herpes zoster virus, your best bet is to avoid getting it in the first place — by getting the two-shot recombinant zoster vaccine called Shingrix.
The Centers for Disease Control and Prevention recommends the vaccine for everyone 50 and older, plus anyone 19 and up who is immunocompromised, including those on medications prescribed for immune-mediated diseases such as rheumatoid arthritis.
The vaccine can cause temporary side effects, including a sore arm, tiredness, muscle pain, headache, chills, fever, stomach pain or nausea, which usually resolves within two to three days.
Although the shingles vaccine is 90% effective at preventing the painful disease, according to the CDC, only 26% of people age 60 and above and only 12% of people in their 50s take advantage of the vaccine, Cohen says, possibly because of the side effects or lack of awareness.
Who Shouldn’t Get the Shingles Vaccine?
Skip the Shingrix vaccine if you are pregnant, currently have shingles or had a severe allergic reaction to your first dose. If you have a fever from a cold or infection, hold off on the vaccine till you’re feeling better.
“Most people don’t realize that shingles is a very serious disease and actually a very common disease,” Cohen says. “Yes, the vaccine has side effects, but if you get shingles and it spreads to your eye, you could lose vision, develop chronic debilitating pain and have an elevated risk of potentially fatal stroke.”
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Shingles on the Face: Symptoms, Treatments and Causes originally appeared on usnews.com
