A reminiscence on shingles

An elderly relative with a pacemaker and AF attended Casualty with acute pain in the right eye. The duty ophthalmic registrar carried out a thorough examination and reported that her eye was absolutely fine.

3 days later she returned with severe iritis associated with H.zoster. Antiviral treatment came too late. She lived with daily and often severe post herpetic neuralgia and ultimately lost the sight in that eye.

No connection with AF of course but I will definitely have the vaccine when I turn 70.

[Hidden]

Yes it certainly is. As much as anything, the post was a heads up for anyone in a similar situation and to encourage others to think about vaccination at 70 or earlier if your GP can find it on a private basis

I wonder if there is a case for a presumptive diagnosis of Zoster with severe intraorbital pain but a completely quiet eye and normal examination.

A few days of antivirals seems justified pending the possible emergence of signs.

[jennydog in reply to Hidden]

I had shingles in the head area some years ago after my sons had chickenpox. I had no rash at all but dreadful ear ache and itchiness. I had anti -viral tablets and saw my GP daily for a fortnight as he was worried about my eyes.

I understand that it is particularly important to have the jab if you have had Shingles as Herpes zoster lies dormant.

[Hidden in reply to jennydog]

Gosh you were unlucky Jenny. Conventional wisdom seems to be that you can get chickenpox from open shingles blisters, but not the other way round.

Shingles is due to a reactivatiion of the chicken pox virus. Since many of us won't know for sure whether we had chicken pox as a child, I would think it worthwhile for all of us to discuss shingles vaccination with our GPs at 70

Shingles tends to affect older people when "run down" , stressed or if the immune system is depressed for whatever reason. The long term pain after shingles is very debilitating and the key to successful treatment is early diagnosis.

I do think it is worth elders like me reading up on all the different ways that shingles can present. Your story suggests your GP was concerned you might have so called Ramsay Hunt syndrome. Or ophthalmic shingles as you said.

The take home is that the diagnosis of shingles is very difficult before the blisters appear. Unexplained pain on one side of the body in a segmental distribution in older age particularly, is worth an urgent assessment.

Just my non medical opinion.

[Hidden]

Good decision. Heroes Zoster can be devastating in the elderly.

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