• Herpes Zoster (Shingles) Complications

Complications of Herpes Zoster

Ear Complications (Herpes zoster oticus):

  • Herpes zoster involving the facial nerve produces the Ramsay Hunt syndrome, which is characterized by intense pain in the ear; herpetic vesicles on the external ear or tympanic membrane, mouth, face, neck, and scalp and transitory one-sided facial paralysis.
  • This syndrome is occasionally associated with vertigo, tinnitus, and hearing disorder.

Complications of Herpes Zoster

Eye Complications:

These occur when the virus affects the ophthalmic division of the trigeminal nerve.

  • Development of corneal surface erosions and ulcerations.
  • Decreased sensation of the cornea, decreased tears, late healing and increased risk of corneal injury.
  • Increased risk of bacterial infection in the eye
  • Zoster uveitis which is a very serious condition that leads to severe eye complaints and pathologies like atrophy of the iris, irregular pupil, corneal edema, formation of cataract and glaucoma too
  • Acute retinal necrosis causing blurring of vision and/or pain in one or both eyes.
  • In a more severe form, there is absence of light perception and detachment of the retina. This condition has a very poor prognosis.
  • Optic neuritis or inflammation of the optic nerve
  • Glaucoma usually seen in patients with severe, chronic or repeated attacks of shingles
  • Cataract also usually seen in patients with severe, chronic or repeated attacks of shingles

Complications of Herpes Zoster

Post Herpetic Neuralgia (PHN):

  • Characterized by constant or intermittent continuation of pain that accompanies the acute episode of shingles. This is the most common complication following shingles.
  • Especially seen in older and may persist for weeks or months after the sores have healed. The pain can be severe enough to be incapacitating especially in elderly persons.
  • In cases of severe or persistent pain, patients can become depressed and on occasions may even become suicidal.

Complications of Herpes Zoster

Secondary Infection:

  • Secondary bacterial infection of the blisters with streptococci or staphylococci can occur after 1-2 weeks with yellowish crusting or discharge from it.
  • Cellulitis is common with the affected area becoming erythematous, tender, firm and hot. Red streaks may appear around the wound.

Central Nervous System Complications:

These usually occur in immunocompromised individuals and include conditions like:

  • Meningoencephalitis, i.e., inflammation of brain and its coverings, resulting in delirium, confusion or coma
  • Myelitis or inflammation of the outer covering membrane of the nerves
  • Cranial nerve palsies or weakness
  • Peripheral facial nerve palsy
  • Cerebrovascular accident such as stroke

Disseminated or Widespread Herpes Zoster:

This happens in immunocompromised persons leading to involvement of multiple dermatomes, many organs or at times even systemic involvement, causing death due to encephalitis, hepatitis, or pneumonitis.

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