An Overview of Herpes Zoster Ophthalmicus

Symptoms, causes, diagnosis, and treatment

Herpes zoster ophthalmicus (HZO) is a serious, vision-threatening infection that affects the eye and the skin surrounding the eye. HZO is caused by reactivation of the varicella-zoster virus, the same virus that causes chickenpox in children. After infection, the virus remains dormant in the nerves and can reactivate, resulting in shingles in people with weakened immune systems. HZO is caused when the virus is reactivated in the nerves that supply the eye area.

The varicella-zoster virus is not to be confused with herpes simplex 1, another virus that causes ​eye herpes. Herpes simplex 1 is the same virus that causes cold sores on the lips and mouth. It sometimes causes an infection of the cornea called herpes simplex keratitis.

An eye dropper letting liquid out


Jrgen Hopf / EyeEm / Getty Images


If you have HZO, you will most likely have a rash on one side of your face or forehead that looks like chicken pox. A group of small blisters may develop around one of your eyes. Up to one week before the rash appears, you may feel ill with fatigue, malaise, and possibly a low-grade fever. In some cases, you may feel pain in the affected area a few days before blisters appear. If your eye becomes infected with HZO, the following symptoms may develop:

  • Severe pain in and around the eye
  • Eye redness
  • Swelling of the eyelid
  • Light sensitivity


HZO is caused by the same virus that causes chickenpox and shingles. People who have had chickenpox or have been exposed to the chickenpox virus may develop HZO. Up to 25% of people with herpes zoster will develop HZO. There is no way to prevent the condition, but it tends to occur more frequently in older people and those who have a compromised immune system. Exercise, stress reduction and maintaining a good immune system may decrease your chance of being affected.


Although there are some medical tests that can be performed to confirm the condition, most healthcare providers can diagnose HZO based on appearance and symptoms. While an early diagnosis may be more challenging, once blisters appear, the diagnosis is often straightforward because of the manner in which the outbreak respects the vertical midline of the body, affecting only one side of the face. One early and obvious sign of an impending case of HZO is the Hutchinson’s sign. The Hutchinson's sign refers to a blister or lesion that erupts on the tip of the nose.


If you are noticing symptoms, be sure to visit your healthcare provider and get diagnosed as early as possible for treatment. If you are diagnosed with HZO, your healthcare provider will prescribe an antiviral medication in an attempt to limit the virus' replication, and reduce subsequent pain and symptoms.

A steroid eye drop may also be prescribed to reduce inflammation. You will also be instructed to keep the affected areas clean and to avoid scratching the lesions in order to prevent scarring or bacterial infection.

To reduce pain, you may be instructed to apply cool compresses to the affected areas. Over-the-counter medicines are sometimes helpful for pain. It is not unusual for cases of HZO to be admitted to the hospital.

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  • Gupta, Deepak. "Herpes Zoster (Shingles) Reactivation of the Varicella-zoster Virus." Optometric Management, December 2006.

  • Sowka, Joseph W, Andrew S Gurwood and Alan G Kabat. "The Handbook of Ocular Disease Management," supplement to Review of Optometry. April 2010.

By Troy Bedinghaus, OD
Troy L. Bedinghaus, OD, board-certified optometric physician, owns Lakewood Family Eye Care in Florida. He is an active member of the American Optometric Association.