Welcome to Case of the Day!
Today, we’re going to discuss an eye disease. Two patients came in with this problem, and since it’s not typical, we thought we could go over that.
Two patients came in with herpes zoster or shingles along their forehead and face on one side, and they both had the zoster vaccine. This is actually the fourth or fifth case that Dr. Croley has seen in his office who had the vaccine to prevent the zoster from happening, but still got it.
Herpes zoster, or shingles, is caused by the same virus that causes chickenpox, and so before you can get shingles, you have to have had chickenpox in your lifetime. Once you’ve had chickenpox, that virus lives in the nerve cells of your nervous system for the rest of your life.
A variety of things (you’ve become ill, weakened, sad, or experience things that typically throw your immune system off) can let shingles pop out. Then you get this rash, and it follows the pathway of a nerve. So it comes around the side of someone’s trunk or chest. In the case of the face, it will follow the course of the fifth cranial nerve, which supplies sensation to the face; typically, it follows the forehead, sometimes the eye and eyelids, which are the first division of the fifth cranial nerve.
Occasionally, Dr. Croley has seen it on the cheek and very rarely down on the jaw area, which is a different division of the fifth cranial nerve. In this typical rash, this little vesicle pops up, opens up, and you get this sort of scaly rash that happens, and it oozes for a while, then slowly dries up.
As far as the eye goes, it affects the lids and the forehead; it can get on the eyelid and the brow area, but if you get a spot along your nose, then that means there’s a very good chance that you’re going to get it in the eye itself. That is a significant sign if you get a lesion on your nose and forehead.
The usual treatment that we put people through is systemic antiviral medications, sometimes prednisone or typically cortisone, and antivirals in their eyes, just as a preventative thing.
In the case of these two ladies, they actually have had the vaccine. The vaccine is recommended for people over age 65 because there’s a higher incidence as we get older; our immune system weakens, and shingles is more likely to pop up.
Unfortunately, the vaccine’s not a guarantee, so there are still people who get a shingles episode after the vaccine. The vaccine is very strong evidence that it decreases your risk of getting it, but it does not a hundred percent stop you from getting it. So far, the cases seen by this clinic are of the less severe type, so maybe the vaccine is allowing you to have a milder case of shingles.
If you’re over 65 and are considering getting the vaccine, we would highly recommend you talk with your medical doctor about what they recommend, and you certainly can get the vaccine in their office.
If you have any questions about shingles or herpes zoster, we’ll be happy to try to answer them through the website. If not, may God bless you with healthy eyes and great vision.
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