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Shingles
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For those of you who are David Letterman fans, you may have noticed that he was absent from his late-night television talk show recently for close to a month.  His absence was attributed to a shingles infection involving the eye.

Shingles is a viral infection that affects many parts of the body.  The particular virus is called the herpes varicella-zoster virus.  The varicella portion of the virus causes chickenpox.  After the chickenpox has cleared, the virus becomes dormant in specific nerve roots of the brain.  If the virus is reactivated later in life, the zoster portion of the virus results in shingles.  A reduction in one’s immunity causes the reactivation.  Such things that can cause a reduction in your immunity include aging, UV exposure, stress, organ transplantation, etc.  Shingles is only contagious to people who have never had chickenpox.

Shingles usually causes a vesicular skin rash on one side of the body, which is more painful and itchy than that of chickenpox.  The face, eyelid, scalp, tip of the nose, ear, back or abdomen are commonly affected.  Before the rash begins, there is usually a prodromal stage of general malaise, fever, or chills. The skin rash presents as small fluid-filled blisters that take around five days to break open and up to four weeks to heal.  Approximately twenty percent of those affected by shingles experience post herpetic neuralgia.  This stage is characterized by pain that continues for months or even years after the initial blisters heal.

When the eyeball is involved, shingles can take on many presentations.  It is virtually impossible for you to know if you are suffering from a shingles infection to the eyeball.  The eye can be red, inflamed, blurred or feel irritated.   Optometrists and ophthalmologists are concerned with the health of the cornea during a shingles infection (clear, front layer of the eye). Corneal ulcers may develop which could potentially lead to scars.  The more severe and chronic the infection, the greater the risk of corneal scar tissue development which can cause permanent vision loss.

Herpes zoster or shingles is typically treated with oral antiviral medications.  The risk of complications can be reduced by initiating treatment as soon as possible.  Topical creams can help alleviate the discomfort from the skin rash.  If the eye is affected, anti-inflammatory drops may also be used.  Treatment however does not kill the virus but rather forces the virus into dormancy again.  Reactivation of shingles can occur at any time in the future.

The symptoms of an ocular shingles infection can mimic those of many other eye conditions.  If your family physician ever suspects you suffer from shingles, it is imperative to seek the care of your local optometrist or ophthalmologist to rule out any eye involvement.