The varicella-zoster virus is responsible for about 1 million new shingles cases in the U.S. each year—and shingles vision side effects occur in about 80,000 of them.
Despite the relative rarity of vision symptoms like sensitivity to light, blurry vision, and even vision loss, Elisabeth J. Cohen, MD, professor in the Department of Ophthalmology and vice chair for academic affairs at NYU Grossman School of Medicine, was well aware that permanent vision damage was a possibility by the time she started experiencing shingles vision symptoms herself.
“My experience began with my right eye burning; since it was close to the Fourth of July, I thought I’d gotten sunscreen in my eye,” Dr. Cohen tells Glamour. “The following day, I was running my hand through my hair and noticed the blisters—I knew that it was shingles.”
Dr. Cohen was immediately diagnosed with herpes zoster ophthalmicus, or HZO, a type of shingles that affects the nerves of the eye.
Shingles occurs when the varicella-zoster virus—the bug responsible for chicken pox—reactivates in the body. After an initial chicken pox infection, varicella-zoster lies dormant in nerve cells, but in some cases, for reasons researchers don’t totally understand, the virus can begin multiplying again, Dr. Cohen says.
As the virus spreads down the nerve pathways, it causes a painful, blistering rash on the skin of the affected area. Shingles most commonly presents near the waist, but it can show up almost anywhere including the genitals and face. “When the virus awakens in the nerve that supplies the forehead and eye, [it can cause HZO],” Dr. Cohen explains.
Shingles vision symptoms caused by HZO might be rare—they show up in only 8 percent of shingles cases—but they are serious. “I developed loss of vision that interfered with my depth perception and had to stop doing surgery and clinical work as a cornea specialist,” Dr. Cohen says.
Among people who have had chicken pox, age is the biggest risk factor for shingles, according to the Mayo Clinic, followed by diseases and medical treatments that compromise the immune system. But that doesn’t mean you can’t get shingles if you’re younger. “Half of all cases occur in people under age 60,” Dr. Cohen says.
HZO can also cause potentially life-threatening complications. This particular type of shingles is a risk factor for strokes and neurological complications. It can also cause lasting vision problems. “It is well known that shingles causes what is known as ‘keratitis’ when it affects the cornea, and ‘iritis’ when it is inside the eye,” Dr. Cohen says. “Both cause pain, redness, decreased vision, and sometimes glaucoma. Repeated flare-ups are associated with chronic eye disease and scarring, as well as vision loss.”
Since her own diagnosis in 2008, Dr. Cohen has dedicated her career to treating HZO and studying the impacts of low-dose antiviral treatments in the Zoster Eye Disease Study conducted at NYU’s Grossman School of Medicine. “I’ve always been interested in infectious diseases, well before I suffered from HZO,” she says. Early in her career she was a regional principal investigator on a study that showed that a year of low-dose antiviral medication reduced episodes of herpes simplex virus disease in the eye. “When HZO damaged my vision and ended my career as a cornea surgeon, I had the idea to try treating herpes zoster the same way.”
The results of the study supported Dr. Cohen’s hypothesis. “If there is eye involvement with keratitis or iritis, our recommendation based on the study is to take a low dose of valacyclovir for a year, after taking the recommended short-term course of the higher-dose valacyclovir treatment, to reduce your risk of having flare-ups of new or worsening eye disease and lessen the dose of pain medication,” she says.
To avoid shingles, including HZO, the most important thing you can do is get vaccinated. The two-dose shingles vaccine is currently recommended for healthy adults over 50 and immunocompromised adults over the age of 19.
If you do develop a shingles rash on your head or neck, Dr. Cohen recommends seeing an ophthalmologist who is a fellowship trained cornea specialist ASAP.
