Shingles in older people

Patient

Q: My husband is 63 years of age and was diagnosed with shingles this past week. He has them on half of his forehead and scalp. He is miserable and sure feels nauseated and sick. The doctor gave him Acyclovir 200 mg. to take 5 times a day. He also gave him Vicodin for pain. He said to watch his eye and today his eye is swollen and has patches on it. The other patches are starting to blister up and I am really worried about his eye. The doctor said to have him see an opthamologist if it got into his eye. Naturally it is the weekend and what to do? Do you have any suggestions about when to see a doctor when it affects the eye. What can an eye doctor do? Special eye drops? I would appreciate any advice that you have for me and does this just have to run it's course? Is he contagious to other people? He works at a state hospital and of course right now just does not feel like working. Any help would be appreciated. Is there anything special to do with the blisters? Thank you!

Doctor

A:   I understand your worry about your husband’s possible ophthalmic Herpes Zoster or Herpes in the eye. I will suggest you to take him to the ophthalmologist as soon as possible to rule out involvement of the eye.
Herpes zoster ophthalmicus could involve the tissues innervated by the compromised nerves of the face and accounts for 10-25% of all cases of shingles. The sequelae of herpes zoster ophthalmicus could be devastating and include chronic ocular inflammation, visual loss, and debilitating pain. A simple evaluation of the eye could give us an early diagnosis to prevent any sequelae.
 
Treatment of acute herpes zoster ophthalmicus is optimal generally if started within 72 hours of rash onset. After a detailed evaluation form the Ophthalmologist, he could treat him with employ different strategies for acute herpes zoster ophthalmicus which include antiviral agents, systemic corticosteroids, antidepressants, and adequate pain control.
 
Depending on the findings, the treatment could simply vary from antiviral agents like the one he is taking at the moment plus the use of additional topical corticosteroids, antibiotics, cycloplegics, antivirals. I wish him a prompt recovery.

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