Herpes zoster, commonly known as shingles, is a viral infection caused by the varicella-zoster virus (VZV)—the same virus that causes chickenpox. After a person recovers from chickenpox, the virus remains inactive in the nervous system and can reactivate years or even decades later as shingles.
Most people associate shingles with a painful, blistering skin rash. However, when shingles develops on the face, it can sometimes affect the eye and surrounding tissues. This condition, called herpes zoster ophthalmicus (HZO), can cause inflammation and potentially serious eye complications.
Recognizing the symptoms and receiving prompt medical care can help protect your eyes and preserve your vision.
What Is Herpes Zoster Ophthalmicus?
Herpes zoster ophthalmicus occurs when the varicella-zoster virus reactivates in the ophthalmic branch of the trigeminal nerve, which provides sensation to the forehead, upper eyelid, and parts of the eye.
The condition typically affects one side of the face. A shingles rash may appear on the forehead, scalp, eyelid, or around the eye. In some people, the eye itself also becomes involved.
Shingles can affect several parts of the eye, including the eyelids, conjunctiva, cornea, iris, retina, and optic nerve.
What Are the Symptoms of Shingles in the Eye?
Symptoms may begin before the characteristic shingles rash appears. A person may initially experience burning, tingling, itching, pain, or unusual sensitivity on one side of the forehead or face.
Other signs and symptoms may include:
- A painful or blistering rash on one side of the forehead, scalp, eyelid, or nose
- Swelling around the eye or eyelid
- Eye redness
- Eye pain or discomfort
- Sensitivity to light
- Watery eyes
- Blurred or decreased vision
- Headache or general fatigue
A rash on the tip or side of the nose can sometimes indicate an increased likelihood of eye involvement because the affected nerve branch also supplies structures within the eye. However, eye complications can occur even when a rash on the nose is not present.
How Can Herpes Zoster Affect Your Vision?
Not everyone with shingles near the eye develops serious eye disease, but herpes zoster ophthalmicus can affect multiple structures within the eye.
Possible complications include:
Keratitis: Inflammation of the cornea, the clear front surface of the eye. Keratitis can cause pain, light sensitivity, blurred vision, and, in some cases, corneal scarring.
Uveitis: Inflammation inside the eye that may cause redness, pain, light sensitivity, floaters, or changes in vision.
Elevated eye pressure and glaucoma: Inflammation associated with herpes zoster can sometimes increase pressure within the eye. Persistent elevated pressure may damage the optic nerve.
Corneal nerve damage: Shingles can damage nerves that provide sensation to the cornea. Reduced corneal sensation can interfere with healing and contribute to chronic eye problems.
Retinal or optic nerve involvement: Although less common, herpes zoster can affect the retina or optic nerve and may result in significant vision loss.
Some eye complications can develop or recur weeks, months, or even years after the initial shingles infection, making appropriate follow-up eye examinations important.
When Should You See an Eye Doctor?
Shingles involving the forehead, eyelid, nose, or area surrounding the eye should be evaluated promptly by a healthcare professional.
Seek medical attention especially if you experience:
- Eye pain or redness
- Blurred or decreased vision
- Sensitivity to light
- Swelling around the eye
- A rash or blisters near the eye
- New floaters or other sudden changes in vision
Early evaluation by an ophthalmologist can help determine whether the eye is involved and whether additional treatment is necessary.
Sudden or significant vision loss, severe eye pain, or rapidly worsening symptoms require urgent medical attention.
How Is Herpes Zoster in the Eye Treated?
Treatment typically includes oral antiviral medication to slow viral activity and reduce the risk of complications.
Treatment is generally most effective when antiviral medication is started as soon as possible, ideally within 72 hours of the rash appearing. However, people with suspected eye involvement should seek medical care even if more than 72 hours have passed.
Depending on how the eye is affected, an ophthalmologist may also prescribe medications to control inflammation, manage eye pressure, or treat other complications.
Steroid eye drops should only be used under the supervision of an eye-care professional, as they are appropriate for some complications but can worsen others if used incorrectly.
Who Is Most at Risk for Shingles?
Anyone who has previously had chickenpox can develop herpes zoster. The risk increases as the immune system becomes less effective at keeping the virus inactive.
Shingles is more common among:
- Adults age 50 and older
- People with weakened immune systems
- People taking certain medications that suppress the immune system
- People undergoing certain medical treatments
Another possible complication is postherpetic neuralgia, in which nerve pain continues for months or longer after the shingles rash has disappeared.
Can Herpes Zoster Be Prevented?
Vaccination is one of the most effective ways to reduce the risk of shingles and its complications.
The CDC recommends the Shingrix vaccine, given in two doses, for adults age 50 and older. It is also recommended for adults age 19 and older who are or will be immunodeficient or immunosuppressed because of disease or therapy.
People who have previously had shingles may still benefit from vaccination because shingles can occur more than once. Your healthcare provider can advise you about whether and when vaccination is appropriate for you.
Protecting Your Vision
Herpes zoster ophthalmicus can range from a relatively mild condition to a serious eye disease. Fortunately, early recognition, antiviral treatment, and appropriate ophthalmic care can reduce the risk of complications.
If you develop a shingles-like rash on your forehead, eyelid, nose, or around your eye—particularly if you also experience eye redness, pain, light sensitivity, or changes in vision—do not wait for symptoms to worsen. Seek medical attention promptly.
At the Discovery Eye Foundation, we believe that education, research, and early intervention are essential to protecting sight. Understanding the warning signs of eye disease empowers people to seek appropriate care and take an active role in preserving their vision.