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HERPES ZOSTER KERATITIS (SHINGLES)

Herpes zoster is caused by the reactivation of the chickenpox virus. After a person has had chickenpox, the virus lies dormant in certain nerves for many years.

Herpes zoster is more common in people with a depressed immune system and those over the age of 50. It's quite rare in children and the symptoms are mild compared to what an adult may experience. Children most at risk for herpes zoster are those who had chicken pox during the first year of life or whose mothers had chicken pox very late during pregnancy.

Symptoms

The symptoms of HZO are as follows:

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  • A prodrome of tingling of the forehead may occur.

  • painful forehead rash

  • severe ocular pain

  • marked eyelid edema

  • conjunctival, episcleral, and circumcorneal conjunctival hyperemia

  • corneal edema; and photophobia

  • skin hypersensitivity in the area where the herpes zoster is to appear

  • mild rash, which appears after five days and first looks like small, red spots that turn into blisters

  • blisters, which turn yellow and dry, often leaving small, pitted scars

Causes

The major known cause for HZO is:

  • The reactivation of varicella virus which causes chickenpox

Risk factors

  • Virulence of the VZV and the immune status of the host are primary factors leading to the development of HZO. The incidence and severity of herpes zoster increases with advancing age with patients over the age of 60 at the highest risk. One study showed that racial factors may play role since elderly black patients were one fourth as likely as elderly white patients to develop herpes zoster.  Further supporting the theory that immune system status plays a role, patients that are treated with immunosuppressive drugs have a significantly increased risk for herpes zoster. An immunocompromised patient is more likely to have a prolonged illness, more likely to recur, and more likely to develop myelitis and vasculopathy. The risk of herpes zoster is 15 times greater in men with HIV than in men without HIV.

Treatment

  • Oral antivirals (eg, acyclovir, famciclovir, valacyclovir)

  • Sometimes topical corticosteroids

  • Medication may help alleviate some of the pain, but the disease has to run its course. Immediate treatment with antiviral drugs may help lessen some of the symptoms and minimize nerve damage.

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