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Eye damage from the herpes zoster virus
Last reviewed: 07.07.2025
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Eye damage caused by the herpes zoster virus, or Herpes Zoster. Symptoms include a rash on the forehead and painful inflammation of all tissues of the anterior and sometimes posterior segments of the eye. Diagnosis is based on the characteristic appearance of the anterior segment of the eye, when it is accompanied by shingles along the first branch of the trigeminal nerve. Treatment is with oral antivirals, mydriatics, and topical glucocorticoids.
Herpes zoster, when there is a lesion on the forehead, affects the eyeball in 1/4 of cases when the nasociliary nerve is involved (as indicated by localization on the tip of the nose), and in 1/3 of cases does not involve the tip of the nose.
[ Symptoms of eye herpes
During the acute phase of the disease, in addition to the forehead rash, there may be marked swelling of the eyelids; conjunctival, episcleral, and pericorneal hyperemia; corneal edema, epithelial and stromal keratitis, uveitis, glaucoma, and eye pain. Keratitis accompanied by uveitis may be severe and is followed by scarring. Late sequelae - glaucoma, cataracts, chronic or recurrent uveitis, corneal scarring, neovascularization, and hyperesthesia - occur frequently and reduce visual acuity.
Diagnosis of herpes of the eye
Diagnosis is based on the presence of a typical forehead rash or history and the presence of atrophic lesions on the forehead. Herpetic lesions of this area, without ocular involvement, are high risk and warrant ophthalmological consultation. Urgent culture, skin immunoassays, PCR, or serial serologic testing are performed when lesions are atypical and the diagnosis is unclear.
Treatment of eye herpes
Early treatment with acyclovir 800 mg orally 5 times daily, famciclovir 500 mg daily, or valciclovir 1 g orally twice daily for 7 days reduces ocular complications. Unlike patients with herpes simplex virus, patients with herpes zoster keratitis or uveitis require topical glucocorticoids (eg, 0.1% dexamethasone instilled every 2 hours initially, increasing the interval to 4 to 8 hours as symptoms improve). The pupil should be kept dilated using 1% atropine or 0.25% scopolamine 1 drop twice daily. Intraocular pressure should be monitored and treated if it increases.
The use of short-term high-dose oral glucocorticoids to prevent postherpetic neuralgia in patients over 60 years of age in good general health remains controversial.