Shingles; Viral Infection and The Eye; 050315


I am 74 and have shingles on my face, involving my eye.


You should to go straight to the doc, okay? This is not something with which you want to waste a tremendous amount of time. The problem with shingles is that if you can catch it within the first several days, 2, 3, 4 days, the antivirals are very, very helpful to stop the progression of the illness. If you wait much past that, it gets harder and harder and harder. The antivirals are still going to be beneficial to you, but they are not going to be quite as beneficial. When these things involve the eye, you really need to jump on it because, if you don’t, it could cost you some degree of eye sight. Or, it can cost you your eye sight altogether. You need to hustle straight to the doctor’s office, and they need to start you on the antivirals.

You might be able to make it until tomorrow, but I woulde probably be inclined to go tonight to get started on these things.

Your best bet is to take something called “Valtrex” or “Valacyclovir”, the dosage is 500 to 1,000 milligrams once a day. You stay on it about 14 days. You can get by with Acyclovir. Howevery, the problem with this, is that you have to take it more than once daily, whereas with the Valacyclovir, it is taken less frequently per day.

Shingles is not an illness that has one phase to it—it has four phases. The first of which, is when the skin feels itchy and burns, and that’s when it’s most easily treated. The infection begins in what is called the “Dorsal root ganglion” of the spinal cord, which is where the chickenpox virus, has been dormant for probably for 70 years. Then it starts to activate, and it starts to irritate, damage, and kill this sensory nerve.
By the time it hits the face, by the time it hits the skin, this infection has already been in place for about 3 to 4 days. Phase number two is where you start seeing death of the axon, death of the nerve cell itself.

Phase number 3 is when the skin starts to slough. You start to see the characteristic, a rash followed by necrosis of the skin. Why would the damage to a nerve cell cause the skin to slough off? It is more like gangrene, but what happens is that as the nerve start to become damaged, the blood vessels go into spasm such that it causes a Ischemia or cell death of the skin, itself.
Phase number 4 is in the healing phase. As the nerves start to heal, the areas where the nerve cuts at a right angle to the tissue, the nerve path can become occluded, halting the healing and leading to Postherpetic Neuralgia. It is actually a 4 stage illness, and you have to jump on this one, or you’re going to have a problem.

Atypical of shingles is when it involves the eye, because then you can end up with secondary infection.

If you can, start taking a strong anti-inflammatory, and an anti-convulsant, for 6 to 10 weeks. The anti-viral is used for 2 weeks. Those are the 3 things you need to be started on. We are going to count on the ER guys to get you started on the antiviral. If they give you a pain pill, that is fine: It doesn’t really matter. However, the anticonvulsant, antiviral, and the anti-inflammatory are what will keep you out of trouble.

About David S Klein, MD 149 Articles
David S. Klein, MD, FACA, FACPM was born in Washington, DC, and was raised in Chevy Chase, Maryland. He completed his undergraduate education at the University of Maryland with degrees in Chemistry and Psychology. Medical School was completed at the University of Maryland at Baltimore, followed by Internship in General Surgery at the University of North Carolina and Residency in Anesthesiology at the Duke University, Durham, North Carolina. Dr Klein has been practicing medicine since 1983, concentrating in Pain Medicine, Minimally Invasive Medicine and Surgery, and Neuroendocrinology. Earning Board Certification in Anesthesiology, Dr. Klein was elected Fellow in the American College of Anesthesiology, and he was elected Fellow in the American College of Pain Medicine. He is currently an adjunct Associate Professor at the University of Central Florida, School of Medicine. He has focused his private practice on treating patients with hormone imbalance issues, nutritional deficiency related medical problems as well as pain related issues and impairment. With a highly-complex, CLIA licensed laboratory in-house, he has been able to provide rapid-turn around analysis efficiently and cost-effectively. Lecturing extensively nationally as well as internationally, Dr. Klein has authored many articles on topics relating to pain, injury and nutritionally modulated illness. His radio show, “Pain Free Living,” received top ratings during the 6 years it was on the air. Currently practicing in Longwood, Florida, Dr. Klein practices entirely in the office setting.