Herpes Zoster Opthalmicus

Herpes zoster is also known as shingles and is caused by the human herpes virus type 3 (same as chicken pox). Herpes zoster opthalmicus presents as painful skin around the eye and blistering rash. It is more common in older people and those who are immunocompromised, those who are malnourished or under physical or emotional stress.

The varicella virus enters the respiuratory system, although it can also be transmitted through direct contact with infected mucosa. After chicken pox is resolved, the virus lies dormant in the body and can remain dormant for many years. When it is reactivated it tends to present as skin eruptions. Herpes zoster opthalmicus generally involves one nerve on one side of the body, therefore it affects one eye and not the other. The symptoms are pain, itching, and rash, conjunctivitis, severe inflammation of the surrounding skin, keratitis, periorbital oedema in the early phases. New lesions can appear for up to 5 days. Complications include post-herpetic neuralgia (has been linked with suicide in those over 70 years) keratitis, conjunctivitis, papillitis, retinitis, optic atrophy and dry eyes. Generally diagnosis is determined by presenting symptoms, not necessarily with the use of viral culture (unless specifically required).

Generally, herpes zoster opthalmicus is treated with systemic anti-virals taken orally. Symptom relief can also be achieved through the use of corticosteroids, opioids, gabapentin and tricyclic antidepressants for neuralgia. Topical treatments can be prescribed for the relief of itching skin, and good hygiene needs to be employed, bathing the area and dressing the eye area daily.

Research into whether the herpes zoster vaccine ought to be made available for those over 70 is currently being undertaken; although it is important to consider that chicken pox is vastly more serious in the elderly than in younger people.

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