Ocular shingles

Shingles is a skin rash caused by a reactivation of the virus that causes chickenpox (varicella zoster virus).

After chickenpox infection, the virus remains in the nerves and can re-emerge at any time. It can affect people of all ages but it is more common as you get older, especially over 50. Those most at risk are the elderly or people with reduced ability to fight infections, those taking medications that affect immunity, for example.


What is ocular shingles?

This is when shingles affects the top of the face, scalp and eye; usually on one side only. It occurs in 10-20% of people with shingles. In some patients, it affects the skin around the eye, in others the eye itself can be involved. It is also called ‘herpes zoster ophthalmicus’.


Symptoms may include:

The first symptoms are a tingling, itching or burning sensation, lasting 1-3 days.

The symptoms then develop into:

  • A red, painful skin rash
  • Small fluid filled blisters that turn into scabs lasting 3-6 weeks.
  • Eyelid swelling, which can be severe. Sometimes this needs antibiotics but a cool compress and time to recover is often all that is needed.


How does shingles affect the eye?

  • Pre-septal cellulitis: inflammation or infection of the skin around the eye.
  • Conjunctivitis: inflammation or infection of the white of the eye. This can cause a red eye and discharge.
  • Keratitis: infection of the cornea (the clear surface or ‘window' of the eye). This can cause
    • A red eye
    • Eye pain or foreign body sensation
    • Sensitivity to light
    • Blurred vision.
  • Uveitis/Iritis: inflammation in the eye.
  • Increased pressure inside the eye.
  • Retinitis: inflammation of the back of the eye (retina).


What is the treatment?

  • Antiviral medication– a 7-10 day course of antiviral tablets (e.g. aciclovir, valaciclovir) as soon as skin lesions develop. This helps reduce the risk of eye involvement and chronic pain. Antiviral eye gel (ganciclovir) may also be prescribed.
  • Steroid eye drops used in cases of inflammation inside the eye. These often need to be decreased very slowly.
  • Other eye drops drops to reduce eye pressure or infection may be prescribed as well.
  • Pain relief – You can take paracetamol. If pain persists, you can get special types of pain medication prescribed by your GP.
  • Advice for contact lens wearers – contact lenses should not be worn until all symptoms have gone.
  • Avoid rubbing or touching your eye it can make symptoms worse.


Does shingles come back?

Most people only get shingles once. A small percentage of people can get it a second time. Vaccination reduces the chances of it occurring.

If you have varicella zoster keratitis, it can become a recurrent problem.

Severe or repeated episodes can result in scarring of the cornea and/or raised pressure inside the eye. Infection can also damage the nerves of the cornea, leading to a lack of sensation.

The recurrent symptoms include eye redness or pain, light sensitivity and/or blurred vision. Each time you have an episode you should see an eye doctor as soon as possible so theycan check your eye and give you the correct medication.


What is post-herpetic neuralgia?

Post-herpetic neuralgia is chronic skin sensitivity orpain that some people get after shingles. It can be treated with pain medication from your GP.


Is shingles contagious?

While you have a blistering rash you can pass the virus to others who have not had chickenpox and then those people can develop chickenpox, but not shingles.

While you have a rash that is not yet dry and crusted, you should avoid contact with newborn babies, pregnant women who have not had chickenpox and people with reduced ability to fight infections.


How can I avoid getting shingles?

Vaccination: The NHS has offered routine shingles vaccination to those aged 70-79 since 2013. From 1 September 2023 it is also being given to those over 65 and to severely immunocompromised individuals aged over 50. This will be extended to those over 60 in due course. To find out if you are eligible, ask your GP. Vaccination has been shown to reduce occurrence of shingles and post-herpetic neuralgia.

Available vaccines:

  • Zostavax live vaccine given as 1 dose, which was commonly used until September 2023.
  • Shingrix – non-live vaccine given as two doses, two months apart which will now be offered as part of the national vaccination programme.


When to seek advice

If you develop blisters around the eye, swollen eyelids, a red or painful eye, light sensitivity, blurred vision, or new floaters you should contact Moorfields for advice or visit your GP / local A&E department.


Administering Eye Drops

video transcript

Before putting in your eyedrops, first check that the drops are still in date.

If you were using a new bottle of eyedrops also check that the seal is not broken make sure you're putting the correct drops into the correct eye.

Let the correct time to instill your drops. Place a clean tissue on a flat surface wash your hands thoroughly with soap and water invert the bottle two or three times to ensure the contents are evenly mixed together.

Remove the lid and place it on the tissue tilt your head back, pull down your lower lid and form a small pocket. Make sure that the tip of the bottle does not come into contact with your skin or eyelashes as it might contaminate the drops.

Look up and gently squeeze the bottle so that a single drop falls into the pocket made by your lower lid.

Blink the drops in press lightly on the inner corner of your eye this enables more of the drop to be absorbed and not run away down your tear duct.

Wipe any excess fluid from your closed eyelids with a clean tissue.

Recap your drop bottle if you have more than one drop to instill. Wait at least 5 minutes before putting in another drop.

Wash your hands with soap and water to remove any traces of medication.

If you have any problems please contact our nurse led helpline service Moorfields Direct on 0207 566 2345