HERPES ZOSTER, PREVENTION, and TREATMENT

After the initial exposure, herpes zoster lies dormant in certain nerve fibers. Also called shingles, zona, and zoster. The culprit is the varicella-zoster virus. Chickenpox and herpes zoster are caused by the varicella-zoster virus (human herpesvirus type 3); chickenpox is the acute invasive phase of the virus (see Herpesviruses: Chickenpox), and herpes zoster (shingles) represents reactivation of the latent phase. Herpes zoster frequently occurs in elderly and HIV-infected patients and is more severe in immunocompromised patients. The site is usually hyperesthetic, and pain may be severe. Fewer than 4% of patients with herpes zoster experience another outbreak. Infection in the trigeminal nerve is particularly likely to lead to severe, persistent pain.

Geniculate zoster (Ramsay Hunt syndrome) results from involvement of the geniculate ganglion. Ear pain, facial paralysis, and sometimes vertigo occur. Ophthalmic herpes zoster results from involvement of the gasserian ganglion, with pain and vesicular eruption in and around the eye, in the distribution of the ophthalmic division of the 5th cranial nerve. Intraoral zoster is uncommon but may produce a sharp unilateral distribution of lesions. No intraoral prodromal symptoms occur. Sores on the nose are a key signal of possible eye involvement. Herpes zoster can cause several problems with the eye and surrounding skin that may have long term effects. Eye problems caused by severe or chronic outbreaks of herpes zoster may include: glaucoma, cataracts, double vision, and scarring of the cornea and eyelids. Herpes zoster causes a wide range of problems affecting the skin and the eye.

Problems affecting the body
• Flu-like symptoms (fever, headache, fatigue)
• Rash
• Red, sensitive, sore skin
• Blisters and sores on the skin
• Pain (may be burning or throbbing), itching and tingling
Problems affecting the eye
• Redness
• Light sensitivity
• Swollen eyelids
• Dry eyes
• Blurred vision (depending on how the eye is affected)
• Corneal inflammation that may lead to scarring
• Inflammation inside the eye and optic nerve
• Glaucoma
• Cataract
• Double vision
• Loss of sensation

Treatment
Herpes zoster is treated with anti-viral, pain and anti-inflammatory medications. Eye drops and ointments may be prescribed to treat ocular problems. In some cases, secondary conditions caused by herpes zoster may require surgery. Those who are infected should avoid contact with people who may be more susceptible to contracting the disease such as: the elderly, children, pregnant women, or anyone with a compromised immune system.

Prevention
Prevention involves preventing primary infection (chickenpox) by using the varicella vaccine in children and susceptible adults. Adults ≥ 60 yr should have a single dose of zoster vaccine (a more potent preparation of varicella vaccine) whether they have had herpes zoster or not. This vaccine has been shown to decrease the incidence of zoster.