From the Guidelines
Shingles in the eye, known as herpes zoster ophthalmicus, requires immediate medical attention with oral antiviral medications such as acyclovir (800 mg five times daily), valacyclovir (1000 mg every 8 hours), or famciclovir (500 mg three times daily) for 7 days. This condition can lead to vision loss if not treated promptly, and treatment should be guided by an ophthalmologist or emergency room visit as soon as possible 1. The varicella-zoster virus can cause severe conjunctival scarring from secondary bacterial infection, leading to cicatricial ectropion, and topical antibiotics may be used to prevent this 1.
Key Considerations
- Topical antivirals alone have not been shown to be helpful in treating VZV conjunctivitis but may be used as additive treatment in unresponsive patients 1.
- Patients with chronic disease may require prolonged treatment with adjustment of the dose according to the clinical response, and immunocompromised patients may need to be treated more aggressively 1.
- Caution is advised in patients with impaired renal clearance, and late sequelae can include dry eye and corneal anesthesia with neurotrophic keratitis 1.
Treatment and Prevention
- Treatment typically includes oral antiviral medications for 7 days, and patients should avoid touching or rubbing the affected eye and avoid contact with others who haven't had chickenpox, especially pregnant women and immunocompromised individuals.
- Symptoms include redness, pain, light sensitivity, tearing, and a rash around the eye or forehead, and complications can include corneal ulcers, increased eye pressure, and permanent vision damage 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Shingles in the Eye
- Shingles in the eye, also known as herpes zoster ophthalmicus (HZO), is a condition that occurs when the varicella-zoster virus (VZV) reactivates in the ophthalmic branch of the fifth cranial nerve 2.
- HZO can cause eye involvement, including conjunctivitis, keratitis, and uveitis, as well as anterior uveitis and acute retinal necrosis in rare cases 2, 3.
- The condition is more common in older and immunocompromised patients, who often experience severe pain and sensory symptoms that can affect their quality of life 2, 4.
Symptoms and Complications
- Symptoms of HZO include paresthesia, severe pain, and characteristic skin changes 2.
- Complications of HZO can include chronic or recurrent ocular disease, vision impairment, and postherpetic neuralgia (PHN) 4, 3.
- PHN is a common and debilitating complication of HZ that can be difficult to manage, requiring assiduous pain management 4.
Treatment and Prevention
- Treatment of HZO typically involves systemic antiviral medication, such as valaciclovir or famciclovir, which can reduce the risk of pain and ocular complications 5, 6.
- Pain management may also involve the use of tricyclic antidepressants, antiseizure drugs, opioids, and topical analgesics 4.
- Prevention of HZO is possible through vaccination against HZ, which can significantly reduce the incidence of HZ and HZO in older adults 3.
- The recombinant adjuvanted vaccine (RZV) is more effective than the live-attenuated vaccine (ZVL) in preventing HZ and HZO 3.