Two types of Herpes viruses are involved in infections of the eye. 1. Herpes Zoster, and 2. Herpes Simplex type I. Of these Zoster or Shingles is the more dramatic, causing pain, swelling and a vesicular rash consisting of fluid-filled blisters around the eye and forehead. Direct involvement of the eye results in redness, glare sensitivity and blurred vision. Shingles is due to a reactivation of the virus in persons previously exposed. It is usually seen in older persons who were affected by the virus in their younger days when it manifested as chicken pox. After first exposure the virus remains inactive in sensory nerves. Reactivation is associated with exposure to someone with chicken pox or shingles or when ones resistance is low eg debilitating diseases, cancer chemotherapy etc. Shingles may affect other parts of the body like the chest and abdomen. When the sensory nerve supplying pain to the forehead, temple and eye (the ophthalmic branch of the trigeminal nerve) is involved then HZO results. HZO should be considered an emergency, as severe consequences may result. These include severe chronic pain and vision loss. In order to ensure proper follow-up and to reduce suffering and risk of vision loss, early diagnosis, prompt and appropriate treatment is extremely important. Diagnosis may be difficult in the early (prodromal) stage before the rash appears. At this stage the patient experiences fever, malaise, headache, and eye pain prior to eruption of the skin rash. A history of recent exposure to chicken pox or shingles, chemotherapy and aged over 60 should raise concern. One should seek medical attention as soon as the rash appears because the disease can be arrested and unpleasant complications avoided. Sometimes a single vesicle or boil is observed and this may be neglected for several days until symptoms get worse. Occasionally HZO presents as an isolated inflammation of the eye that is difficult to distinguish from other more benign causes of a red eye - conjunctivitis. A vesicle present at the tip of the nose is a sign that the cornea and inner structures of the eye may be involved. This will result in prolonged inflammation associated with grittiness, watering, glare sensitivity, blurred vision and eye pain. Consequences include chronic eye pain, dry eyes, recurrent infection or inflammation, corneal scarring, cataract, glaucoma and loss of sight. Risk
You are at increased risk of getting shingles if you: Had chickenpox as a child Are age 60 or older because your immune system weakens as you age Have a weakened immune system because of a disease like cancer, HIV infection, or AIDS Take medicine that weakens your immune system, such as chemotherapy or radiation for cancer
Prevention: Varicella-Zoster Shingles vaccination in patients over the age of 60 appears beneficial in reducing the rate of HZO.
Can Shingles be spread? Shingles cannot be passed from one person to another. However, the virus can be spread from a person with active shingles to another person who has never had chicken pox. In such cases, the exposed person might develop chicken pox, but they would not develop shingles. The virus is spread through direct contact with fluid from the blisters caused by shingles. A person is not infectious before the blisters appear and once the rash has developed crusts, the person is no longer contagious. Shingles is less contagious than chickenpox and the risk of a person with shingles spreading the virus is low if the rash is covered.
If you have shingles: Keep the rash covered. Avoid touching or scratching the rash. Wash your hands often to prevent the spread of varicella zoster virus. Until your rash has developed crusts, avoid contact with Pregnant women Premature or low birth weight infants and People with weakened immune systems, such as people receiving immuno-suppressive medications or undergoing chemotherapy, organ transplant recipients, and people with human immunodeficiency virus (HIV) infection. Treatment
Shingles of the eye must be treated by an ophthalmologist. Other members of the medical team, depending on the severity, may include a dermatologist and neurologist. Medications will include antiviral drugs, pain killers, steroidal and non-steroidal anti-inflammatory medications, antibiotic eye preparations and topical applications to the skin. Surgery may be required to deal with complications such as corneal scarring. Presented as a public service by the Caribbean Eye Institute. Please email all eye-related concerns to Caribeyett@icloud.com
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Shingles of the eye - Trinidad & Tobago Express
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