External Disease


Herpes Zoster Ophthalmicus

Herpes zoster ophthalmicus, also known as ocular shingles, is an infection caused by the varicella-zoster virus (VZV), the same virus responsible for chickenpox. The virus can remain dormant in the body for many years after an outbreak of chickenpox and may reactivate at another point in time. Commonly resulting in rashes on the body, shingles can also affect the eyes.

When the virus reactivates, it usually travels through nerve fibers to infect other parts of the body. The virus may travel to the upper part of the body, affecting the head and the neck. Almost 50 percent of those affected with shingles, in the head and neck area, have corneas that are infected with the virus.

Ocular shingles can occur in anyone exposed to the varicella-zoster virus but people with weakened immune systems or over 80 years of age and older have an increased risk of developing the illness.

Symptoms of Ocular Shingles

Ocular shingles often produces extreme pain on one side of the face, a rash or redness developing in the eye region or on the forehead, eye redness, inflammation of the eye and vision problems. If left untreated, ocular shingles can lead to the following:

  • Corneal infection
  • Corneal scarring
  • Retinitis
  • Glaucoma
  • Significant vision loss

Treatment of Ocular Shingles

Ocular shingles of the eye is often treated with antiviral eye drops or oral medication, depending on the area of the eye that is affected. If the medication is not administered within the first few days of the appearance of symptoms, it may not be effective. In some cases, steroid eye drops may be prescribed to relieve swelling. An ophthalmologist or cornea specialist should be consulted in order to manage this condition.

Punctal Plugs

Punctal plugs, also known as punctum plugs, lacrimal plugs or occluders, are a method of treating dry eyes. Punctal plugs can relieve dry eye symptoms when eye drops or ointments fail. Punctal plugs are placed in the opening of the tear duct, reducing the natural drainage of tears and keeping the eyes moist. Punctal plugs can be a temporary or permanent solution to dry eyes.

Typically, a temporary or dissolvable punctal plug is implanted in the lower drainage channel of the eye, which is responsible for 80 percent of the eye’s tears. These temporary plugs will usually last a few days to several months. If there is a successful response to the temporary punctal plug, a more permanent punctal plug is implanted.

Punctal plugs come in a few different shapes and sizes, and are no larger than a grain of rice. The plug may be placed in the lower or upper eyelid or both eyelids. Implantation takes only a few seconds in a physician’s office.


Xeomin® is a prescription medication used to effectively treat intramuscular conditions such as blepharospasm, or abnormal involuntary closing of the eyelid.

Xeomin is composed of botulinum toxin type A, a naturally occurring protein that is produced by the bacteria Clostridium botulinum. Xeomin is injected into the affected muscles in order to reduce their activity. Xeomin does not stop the muscle from moving entirely; instead, it modifies the contractions. This is achieved by inhibiting a body chemical called acetylcholine from signaling all of the nerves within the muscle to contract.

Blepharospasm is a condition involving abnormal involuntary spasms of the eyelids. Injections of Xeomin administered into the muscles of the eyelid can help relieve spasms for many patients.

The number of injections necessary will vary from patient to patient, depending upon the number of muscles affected and the severity of the condition. The results of treatment with Xeomin are usually seen after one week and last, on the average, up to 12 weeks.

Risks of Xeomin Treatment

While an effective medication for muscle spasms, treatment with Xeomin carries certain risks. Whether they occur hours or weeks after treatment, the following symptoms may be life-threatening and require urgent medical attention:

  • Difficulty speaking, swallowing or breathing
  • Muscle weakness throughout the body
  • Double vision
  • Blurred vision
  • Drooping eyelids
  • Change in voice quality
  • Problems with articulation
  • Loss of bladder control