From the Guidelines
Discharge instructions for a patient with shingles of the eyelid should include immediate follow-up with an ophthalmologist within 24-48 hours, as ocular involvement can lead to serious complications including vision loss. The patient should take prescribed antiviral medications, such as acyclovir, valacyclovir, or famciclovir, for 7-10 days to reduce viral replication and prevent complications 1. It is essential to use prescribed pain medications as directed, which may include acetaminophen, NSAIDs, or in severe cases, gabapentin or pregabalin for neuropathic pain.
Some key points to consider in the discharge instructions include:
- Applying cool, wet compresses to the affected eye for comfort, but avoiding direct pressure
- Not touching or scratching the rash to prevent bacterial superinfection and viral spread
- Keeping the area clean using mild soap and water, then patting dry gently
- Isolating from pregnant women, infants, and immunocompromised individuals who haven't had chickenpox, as the virus can cause primary varicella infection in susceptible contacts
- Returning to the emergency department immediately if the patient experiences increasing eye pain, vision changes, eye redness, or spreading of the rash
- Completing the full course of medications even if symptoms improve
In terms of ocular care, the patient should apply lubricant eye drops, such as nonpreserved hyaluronate or carmellose, two-hourly to prevent corneal exposure and reduce the risk of ulceration and infection 1. The patient should also be advised to have daily ophthalmological review during the acute illness to monitor for any complications.
It is crucial to note that shingles around the eye (ophthalmic zoster) requires aggressive treatment because the virus can affect the cornea, retina, and optic nerve, potentially causing permanent damage if not properly managed. Therefore, close follow-up with an ophthalmologist and adherence to the discharge instructions are essential to prevent long-term complications and promote optimal recovery.
From the Research
Discharge Instructions for Shingles of the Eyelid
- The patient should be advised to take antiviral medication as prescribed, such as valaciclovir or acyclovir, to help manage the symptoms of shingles and reduce the risk of complications 2, 3, 4.
- The patient should be instructed to keep the affected area clean and dry to prevent infection, and to avoid touching or rubbing the affected area to prevent spreading the virus to other parts of the body 5.
- The patient should be advised to seek medical attention immediately if they experience any signs of complications, such as increased pain, redness, or swelling, or if they have difficulty seeing or experience sensitivity to light 3, 4.
- The patient should be informed about the importance of pain management and the available treatment options, such as over-the-counter pain medications or prescription medications, to help manage postherpetic neuralgia 6.
- The patient should be advised to follow up with their healthcare provider to monitor the progress of the condition and to adjust the treatment plan as needed 2, 3, 4.
Follow-up Care
- The patient should be scheduled for a follow-up appointment with their healthcare provider to assess the healing of the skin lesions and to monitor for any signs of complications 4.
- The patient should be advised to keep their follow-up appointments to ensure that the condition is properly managed and to prevent any long-term complications 5.
Prevention of Future Episodes
- The patient should be informed about the availability of vaccines to prevent shingles, such as the live attenuated VZV vaccine and the recombinant adjuvanted VZV glycoprotein E subunit vaccine, and the importance of getting vaccinated to prevent future episodes 5.
- The patient should be advised to discuss their vaccination options with their healthcare provider to determine the best course of action for their individual needs 5.