Herpes Zoster Ophthalmicus: Shingles of the Eye

Doctor examining facial rash. Uwe Umstatter

Herpes zoster ophthalmicus (HZO) is a serious, vision-threatening infection that affects the eye and the skin surrounding the eye. HZO is caused by reactivation of the varicella-zoster virus, the same virus that causes chicken pox in children. After infection, the virus remains dormant in the nerves and can reactivate, resulting in shingles in people with weakened immune systems. HZO is caused when the virus is reactivated in the nerves that supply the eye area.

The varicella-zoster virus is not to be confused with herpes simplex 1, another virus that causes eye herpes. Herpes simplex 1 is the same virus that causes cold sores on the lips and mouth. It sometimes causes an infection of the cornea called herpes simplex keratitis.

Symptoms of HZO

If you have HZO, you will most likely have a rash on one side of your face or forehead that looks like chicken pox. A group of small blisters may develop around one of your eyes. Up to one week before the rash appears, you may feel ill with fatigue, malaise, and possibly a low-grade fever. In some cases, you may feel pain in the affected area a few days before blisters appear.

If your eye becomes infected with HZO, the following symptoms may develop:

Causes of HZO

HZO is caused by the same virus that causes chickenpox and shingles.

People who have had chicken pox or have been exposed to the chicken pox virus may develop HZO.

Up to 25% of people with herpes zoster will develop HZO. There is no way to prevent the condition, but it tends to occur more frequently in older people and those who have a compromised immune system. Exercise, stress reduction and maintaining a good immune system may decrease your chance of being affected.

Diagnosis of HZO

Although there are some medical tests that can be performed to confirm the condition, most doctors can diagnose HZO based on appearance and symptoms. While early diagnosis may be more challenging, once blisters appear, the diagnosis is often straightforward because of the manner in which the outbreak respects the vertical midline of the body, affecting only one side of the face.

One early and obvious sign of an impending case of HZO is the Hutchinson’s sign. The Hutchinson's sign refers to a blister or lesion that erupts on the tip of the nose.

Treatment of HZO

If you are noticing symptoms, be sure to visit your doctor and get diagnosed as early as possible. If you are diagnosed with HZO, your doctor will prescribe an antiviral medication in an attempt to limit the virus' replication, and reduce subsequent pain and symptoms. A steroid eye drop may also be prescribed to reduce inflammation. You will also be instructed to keep the affected areas clean and to avoid scratching the lesions in order to prevent scarring or bacterial infection.

To reduce pain, you may be instructed to apply cool compresses to the affected areas. Over-the-counter medicines are sometimes helpful for pain.

It is not unusual for cases of HZO to be admitted to the hospital.


Sowka, Joseph W, Andrew S Gurwood and Alan G Kabat. "The Handbook of Ocular Disease Management," supplement to Review of Optometry. April 2010.

Gupta, Deepak. "Herpes Zoster (Shingles) Reactivation of the Varicella-zoster Virus." Optometric Management, December 2006.

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