Associated symptoms

Shingles in the eye usually leads to a typical course of the disease. It usually begins with a burning sensation and severe pain in the area supplied by the affected nerve. The area of the forehead, bridge of the nose and tip of the nose are particularly affected.

It is also possible that these areas may have a reduced sensitivity of the skin and, if the eye is affected, also of the cornea. These symptoms usually occur a few days before the appearance of the typical skin changes. Patients often also suffer from a worsened general condition, tiredness, exhaustion and possibly fever.

If the eye is also affected, this can lead to conjunctivitis, corneal inflammation, inflammation of the iris in the eye or optic nerve inflammation. And so, at the beginning of a zoster ophthalmicus, there may be photophobia, increased lacrimation, redness and swelling of the eye. Later on, small blisters and pustules appear in small groups, which are painful, itchy and burst open and become yellowish-brown incrusted.

The formation of blisters takes two to three days and the content of the blisters is highly infectious.

Incubation period of shingles
How contagious is shingles
Zoster oticus

Zoster ophthalmicus can also cause swelling around the eyes, especially around the eyelids. Similar to the formation of blisters, swelling usually occurs on one side only.

In addition, the infectious content of the vesicles (blisters) can cause inflammation of the conjunctiva. If eye involvement occurs in the context of herpes zoster ophthalmicus, eye pain may occur. These are caused by the fact that the inflammation of the front part of the eye can cause the chamber angle to be displaced, which is normally responsible for the drainage of ocular fluid.

If this is not possible, the intraocular pressure increases, which can lead to eye pain due to pressure on the optic nerve. Furthermore, eye pain can be caused by the involvement of all structures of the eye, such as the conjunctiva or cornea, which can also lead to pain. If the eye and especially the eyelids are involved, an infection of the lacrimal ducts can occur.

The tear ducts swell up and the tear fluid can no longer be drained towards the nose. An uncontrolled watery eye follows.Usually this is only limited to the duration of the disease. However, if there is scarred healing of the lacrimal ducts, these can be permanently constricted, which makes the condition of the watery eye permanent.

In some cases, this can be remedied by a minor surgical procedure. A reddened eye occurs mainly when the conjunctiva is involved, which is the case in up to 90% of cases of herpes zoster ophthalmicus. In addition to the increased vascular drawing, small bleedings (petechiae) are visible.

In addition, swelling of the eyelids and increased tear production are usually found. The outbreak of a herpes zoster in the face is preceded by a preliminary stage lasting several days. In this stage, the affected dermatome, i.e. the area of skin that is supplied by the affected nerve fibers, experiences a phased or permanent burning, itching, numbness and pain. The occurrence of these symptoms can lead to false suspected diagnoses, since at this stage there are no shingles-typical skin changes and thus the diagnosis of zoster ophthalmicus cannot yet be made.