Shingles Vaccine and Herpes Zoster Eye Disease

Shingles vaccine is the best tool we have to prevent herpes zoster ophthalmicus.

The eye is involved in roughly 10 to 20 percent of shingles cases.

Ocular disease can cause chronic pain, scarring and vision loss.

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What Is Herpes Zoster Ophthalmicus

It is reactivation of varicella zoster virus in the ophthalmic division of the trigeminal nerve.

A painful vesicular rash covers the forehead and upper lid.

Eye involvement is likely when the nose tip is affected.

See herpes zoster ophthalmicus.

Why the Shingles Vaccine Matters for the Eye

Zoster can inflame the cornea, uveal tract and retina.

Chronic and recurrent disease occurs.

Prevention is easier than treatment.

Therefore, vaccination protects the eye as well as the skin.

Shingles Vaccine Types

The recombinant adjuvanted vaccine is given in two doses.

The older live vaccine used one dose.

Compared with it, the recombinant product is more effective and lasts longer.

So most guidelines now prefer it.

Evidence for the Recombinant Vaccine

Trials showed more than 90 percent efficacy against shingles in older adults.

Protection remained high across age groups.

Data on eye disease come from observational studies.

Also, results suggest a lower risk of ocular zoster.

Who Should Receive the Shingles Vaccine

Adults aged 50 years and older are the main group.

Immunocompromised adults also qualify in many programs.

People who already had shingles should still be vaccinated.

Therefore, ask about vaccination status in every zoster case.

Shingles Vaccine After Herpes Zoster Ophthalmicus

Prior disease does not give lifelong protection.

Recurrence is possible.

Vaccination after recovery may lower this risk.

So advise it once the acute illness has settled.

Safety of the Shingles Vaccine

Arm pain, fatigue and mild fever are common after the injection.

Serious reactions are rare.

These effects last a few days.

Therefore, counsel patients before the visit.

Immunocompromised Patients

Patients on biologics and transplant recipients have a higher zoster risk.

The recombinant vaccine is non-live and can be used.

Timing relative to immunosuppression matters.

Also coordinate with the treating physician.

Treating the Acute Eye Disease

Oral antiviral treatment started within three days reduces complications.

Examine the cornea, anterior chamber and pressure.

Topical steroids may be needed for stromal disease.

In addition, refer for chronic pain.

Zoster Eye Disease Study

A large trial is testing long-term valacyclovir to prevent complications.

Results will refine care.

Until then, use standard antiviral treatment for acute disease.

Also keep up vaccination efforts.

Counseling Patients

Explain that shingles can attack the eye.

Describe warning signs such as a rash near the nose.

Advise immediate review for any eye redness or pain.

Therefore, patients seek care earlier.

Public Health Role

Eye clinics can ask about vaccination status and refer patients to primary care.

Posters in waiting rooms encourage uptake.

Vaccination reduces the burden on eye services.

So include it in routine counseling.

Pitfalls to Avoid

• Do not assume prior shingles prevents further attacks
• Never miss eye involvement when the nose tip is affected
• Avoid delaying antivirals beyond 72 hours
• Do not forget to ask about vaccination

Shingles Vaccine and Chronic Pain

Postherpetic neuralgia follows a large share of zoster cases.

Because the vaccine lowers the chance of shingles, it also lowers this pain.

In addition, it prevents the nerve damage that causes it.

Therefore, patients gain more than eye protection.

Shingles Vaccine in Eye Clinics

Eye clinics see patients at the moment they recover from zoster.

This is the best time to raise the topic of vaccination.

If the clinic has a leaflet, patients retain the message.

Then they can arrange the injection with their physician.

Shingles Vaccine Schedule

The two doses are given two to six months apart.

Because a late second dose still works, do not restart the series.

Patients with weak immunity may need a shorter interval.

So follow national guidance.

Shingles Vaccine and Myths

Some patients believe the vaccine causes shingles.

The recombinant vaccine is not a live virus.

However, mild reactions are common for a day or two.

Therefore, explain these effects in advance.

Shingles Vaccine Access

Coverage and cost vary between countries.

If cost is a barrier, discuss it with the patient’s physician.

Also check whether the vaccine is part of a local program.

Because the benefit is high, make the effort.

For the latest studies, see the PubMed results for shingles vaccine.

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References

1. Lal H, Cunningham AL, Godeaux O, et al. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med. 2015;372:2087-2096.
2. Kong CL, Thompson RR, Porco TC, Kim E, Acharya NR. Incidence rate of herpes zoster ophthalmicus: a retrospective cohort study from 1994 through 2018. Ophthalmology. 2020;127:324-330.
3. Liesegang TJ. Herpes zoster ophthalmicus: natural history, risk factors, clinical presentation, and morbidity. Ophthalmology. 2008;115:S3-S12.
4. Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for use of herpes zoster vaccines. MMWR Morb Mortal Wkly Rep. 2018;67:103-108.