Shingles is a common viral skin disease caused by a reactivation of the varicella-zoster virus, a member of the herpes virus family, which is the virus responsible for chickenpox.
The annual incidence is between 1.5 and 4 new cases per thousand.
It is much more common in the elderly and in immunocompromised patients (including AIDS).
The three main forms of shingles are the intercostal form, the most common, and the ophthalmic and otitis forms, which carry a significant risk of complications.
ophthalmic shingles, which interests us more particularly, represents approximately 10% of forms of shingles and requires urgent treatment by the Ophthalmologist in order to assess the possible ocular damage and to adapt the treatment. If left untreated, ophthalmic zoster can impair the quality of vision due to damage to the cornea.
The symptoms of ophthalmic shingles:
The patient consults for dysesthesia and pain exacerbated by even minimal stimuli. Shingles often occurs without any obvious cause, but a physiological stress (infectious disease, trauma) or psychological trigger can be found.
Diagnosis is easier in the next phase when there is a rash, associated with an infectious syndrome and sensory disturbances.
The rash: it is cyclical, unilateral, with a characteristic topography.
It begins with red patches, separated by intervals of healthy skin. Vesicles appear after a few hours, isolated or in clusters, filled with a clear then cloudy liquid, giving an ulceration covered with a crust which falls off between the tenth and fifteenth day, leaving an atrophic scar.
The development occurs in two or three successive bursts, with the coexistence of elements of different ages and disappearance in two to six weeks.
The rash remains localized in the territory of one or more of the branches of the ophthalmic nerve and can affect the forehead, the area around the eye (adnexa of the eye, eyelids, etc.) and the cornea, unilaterally.
Corneal involvement is not visible by direct examination, and requires examination by slit lamp and instillation of a staining product, fluorescein under blue light.
The diagnosis is sometimes obvious, sometimes more difficult, the picture can simulate a herpetic attack, erysipelas, dacryocystitis, eyelid eczema, etc.
The main complications of ophthalmic shingles are:
-keratitis (25 to 30% of cases), the complicated form of which progresses to opacification, perforation and anesthesia of the cornea.
-uveitis, which can become complicated by glaucoma.
-Damage to the retina or optic nerve can lead to reduced visual acuity or even monocular blindness.
-Optic neuritis(see our uveitis chapter).
-Superinfection.
Treatment of ophthalmic shingles:
Antiviral treatment is systematic.
Acyclovir or valaciclovir, used orally for at least one week, are indicated to prevent ocular complications.
The ophthalmologist, based on the corneal examination, will judge the appropriateness of additional treatment (acyclovir eye ointment, lubricating gels).
Corticosteroids are contraindicated because they can cause a flare-up of the disease.
