Shingles – Opthalmic Zoster (Eye Involvement)

Opthalmic Zoster is a severe complication that can occur when shingles involves the V1 branch of the trigeminal nerve as the eye can be involved causing severe ocular complications. Typically, I encounter Opthalmic Zoster about once a month in my The Woodlands dermatology and Conroe dermatology clinics. When the V1 branch of the trigeminal nerve is involved, there is a 34% chance of ocular involvement, but when the external branch of the nasociliary nerve is affected the patient will have a 76% likelihood of ocular sequelae. Herpetic vesicles on the tip of the nose indicate that the external branch of the nasociliary nerve is involved and is called Hutchinson’s sign. Herpetic vesicles on the eyelid margin almost always indicate ocular involvement. The most common form of ocular involvement from shingles is uveitis in 92% of all patients and 50% of patients experience keratitis. When I detect shingles in the V1 distribution of the face, I am immediately concerned about Opthalmic Zoster, which is an ocular emergency.  Treatment is based on the ocular anatomy affected: Blepharitis/Conjunctivitis- Cool compresses, topical antibiotics, Valtrex 1g 3x/day for one week; Keratitis- topical steroids, Valtrex 1g 3x/day for one week; Uveitis- topical steroids, oral steroids, Valtrex 1g 3x/day for one week; Scleritis- topical non-steroidal anti-inflammatory agents, Valtrex 1g 3x/day for one week; Retinal necrosis- IV Acyclovir, possible surgical treatment. Opthalmic Zoster is a dermatologic emergency so I urge any patient concerned that they have shingles on their face to urgently call my office to be seen immediately as I reserve openings everyday in both my Woodlands and Conroe dermatology clinics for emergency skin disorders.