Eye shingles: Causes, symptoms, treatments

Closeup of a man with eye shingles
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You may think of shingles as a painful red rash on the body that causes a few weeks or months of misery before it goes away, but shingles also can strike the eye and cause lasting damage to your vision.

And more people are getting eye shingles.

The number of eye shingles cases in the United States tripled from 2004 to 2016, according to Kellogg Eye Center research presented at the 2019 Association of Vision and Ophthalmology meeting.

The researchers found that people over age 75 are most at risk. Whites and women also had a higher incidence of eye shingles.

One explanation for the increase? Few Americans are getting vaccinated for shingles, which is the best way to avoid it – and protect your eyes – in the first place, says Dr. Christopher Rapuano, MD, chief of cornea service at Wills Eye Hospital, one of the top U.S. ophthalmic specialty hospitals.

“Shingles can cause bad things to happen to the eyes, and some of those things can happen even with good treatment,” he says.

CONCERNED ABOUT EYE SHINGLES? Find an eye doctor near you and make an appointment.

What causes shingles?

Before we take a closer look at shingles in the eye (herpes zoster ophthalmicus), let’s talk about what causes shingles in the first place: the chickenpox virus.

As an adult, you may have a hazy memory of spending a week in bed, your itchy body dotted in pink calamine lotion as you binged on daytime TV and ate popsicles by the box.

The blisters may be long gone now, but the chickenpox virus still lies dormant in your body.

About one in three U.S. adults will get shingles  when the varicella-zoster virus that sparked their childhood chickenpox reactivates in the body.

Shingles typically starts out as a band of tenderness or tingling on your skin and then turns into a painful rash.

“People will tell you, ‘It was the worst pain I ever had,’” Rapuano says.

Can you get shingles in the eye?

It’s most common to get shingles on your chest, back or legs but you can get shingles on the face and eye, Rapuano says. About 15 percent of cases involve shingles in the eye area, he says.

However, there’s a difference between having shingles around the eye and having shingles in the eye, which doctors refer to as “eye involvement,” Rapuano says. A patient can have shingles around the eye area without the eye itself being involved, he says.

About half of people who have shingles on the forehead or nose will also have eye shingles.

Eye shingles typically occurs in one eye on the same side of the face as the rash, and eye shingles typically occur after the shingles rash has cleared up, Rapuano says.

A patient who has had shingles on the face may feel like they’re healing well but then notice a symptom such as redness in the eye. When this happens, patients “need to see an eye doctor right away,” Rapuano says.

Symptoms of shingles in the eye

The symptoms of shingles around the eye may be different from the symptoms of eye involvement. Symptoms of shingles around the eye  area may include:

  • Tingling on the face
  • Blisters or rash on forehead or nose
  • Swollen eyelid 

These symptoms may indicate eye involvement in shingles:

Patients who have shingles on the face should get antiviral treatment for shingles and also see an eye doctor right away to check for shingles in the eye.

Because the eye can become involved later, it’s important to follow up with the eye doctor even if your eye looks fine at first.

NEED TO SEE AN EYE DOCTOR? Find a local optometrist and schedule an appointment.

Treatments for shingles around the eye

The treatment for shingles around the eye is the same as treatment for shingles on any other area of the body. Three antiviral drugs -- acyclovir, valacyclovir and famiciclovi -- have been approved for treatment of shingles.

These drugs can:

  • Shorten the length of a shingles outbreak.
  • Make shingles less painful.
  • Reduce the chances of post-herpetic neuralgia, a complication that can cause ongoing pain and sensitivity after the rash goes away. 

In addition to these overall benefits, prompt treatment with antiviral medication can halve the incidence of eye disorders in eye shingles patients.

Without antiviral medication, 50 percent of eye shingles patients will develop eye disorders compared with only 25 percent of patients who take the medicine.

It’s crucial to begin taking antiviral medication within 72 hours of the outbreak of the rash. “It should be started as soon as possible after the rash starts,” Rapuano says.

Treatments for shingles in the eye

There is a different treatment for shingles in the eye. If your doctor diagnoses eye involvement, you may also need eye drops for shingles. There are two main types of eye drops for shingles:

  • Corticosteroid eye drops – Steroid drops can reduce the eye inflammation caused by shingles, Rapuano says. This lowers the chances of complications from shingles of the eye.
  • Pupil dilating eye drops – Your eye doctor also may prescribe eye drops to keep the pupils open for pain relief and to prevent glaucoma caused by shingles.

Recovery from eye shingles

Recovery time varies by patient and the specific case, Rapuano says. “If the inflammation is mild and the treatment is pretty aggressive, then symptoms may start getting better within days,” he says.

At some point, the eye doctor may try to slowly wean the patient off steroids. But a recurrence of inflammation signals a need to keep using steroid eye drops.

“Many patients will need to be on low-dose steroids for years, if not forever,” Rapuano says.

Can eye shingles cause blindness?

Even with proper treatment, some eye shingles patients still develop eye disorders such as glaucoma.

For example, eye shingles can cause:

In the most severe cases of eye shingles, a patient may need a corneal transplant or even removal of an eye.

Now that you’re aware of the dangers of eye shingles, you may wonder whether eye shingles is contagious. Eye shingles cannot be spread to another person.

However, a person who has shingles anywhere on the body can transmit chickenpox to someone who hasn't had chickenpox or been vaccinated.

Preventing shingles in the eye

When it comes to shingles – and especially eye shingles – prevention is the best medicine.

Fortunately, there are two shingles vaccines:

  • Shingrix – A fairly new vaccine approved by the U.S. Food and Drug Administration in late 2017, Shingrix is recommended for adults ages 50 and up. You get Shingrix in two doses two to six months apart, and it’s more than 90 percent effective in protecting you from shingles and post-herpetic neuralgia. Protection stays strong for at least four years after you get vaccinated.
  • Zostavax – An older vaccine for shingles, Zostavax is a live vaccine that is less effective but may be used in healthy adults ages 60 and up if there’s a reason they can’t get Shingrix. For example, someone who is allergic to a component of Shingrix may opt for Zostavax.

The availability of a newer, more effective vaccine should prevent more people from getting shingles. “We recommend the vaccine for all of our patients,” Rapuano says.

Page updated September 2019