Conditions We Treat
Ocular Shingles (Herpes Zoster Ophthalmicus)
Ocular shingles, or herpes zoster ophthalmicus (HZO), is shingles that involves the eye and the skin around it. Shingles is a reactivation of the chickenpox virus (varicella-zoster virus), which stays dormant in the nerves for decades after a childhood infection. When it reactivates in the nerve that supplies the forehead and eye, it can threaten vision and needs prompt attention.
What it looks like
HZO usually begins with pain, tingling, or headache on one side of the forehead, followed by a painful, blistering rash that stays on one side and stops at the midline. A key warning sign is Hutchinson's sign — a rash on the tip or side of the nose — which indicates a higher chance that the eye itself is involved. Any shingles rash near the eye or forehead should prompt an eye exam.
How it can affect the eye
The virus can inflame many parts of the eye, sometimes weeks after the rash appears:
- Redness and irritation of the eyelids and conjunctiva
- Keratitis — corneal inflammation that can scar or reduce corneal sensation (a "neurotrophic" cornea)
- Uveitis — inflammation inside the eye
- Elevated eye pressure, which can lead to glaucoma
- Long-term nerve pain in the area (postherpetic neuralgia)
How we treat ocular shingles
- Oral antiviral medication (acyclovir, valacyclovir, or famciclovir) is the cornerstone of treatment and works best when started early — ideally within 72 hours of the rash. It shortens the outbreak and lowers the risk of eye complications.
- Targeted eye treatment — lubrication for the surface, prescription anti-inflammatory or steroid drops for inflammation (used under close supervision), and pressure-lowering drops if needed.
- Ongoing monitoring — because complications can appear or recur over months, we follow HZO closely and manage flare-ups and any nerve-related dryness of the cornea.
Prevention: the shingles vaccine
The shingles vaccine (Shingrix) is recommended for most adults age 50 and older and substantially reduces the risk of shingles and its eye complications. If you've had ocular shingles, vaccination can still help prevent future episodes — ask your primary care physician.
If you develop a painful rash on your forehead, eyelid, or nose, or a red painful eye after a shingles outbreak, please be seen promptly.
This page is for general education and is not medical advice. If you have symptoms or concerns, please request an appointment for an evaluation.