Shingles are caused by the Varicella-zoster virus, the same virus that causes chicken pox. Eye shingles, also called herpes zoster ophthalmicus, are present when the virus affects the eyes. This occurs in 10 to 25 percent of cases, according to the American Academy of Family Physicians. Eye shingles are primarily treated with antiviral medication, and steroids for secondary inflammation. Antibiotics are only used to treat eye shingles when there is a risk of secondary bacterial infections, and only as a supplement to primary treatment.
Erythromycin Ointment
Broad-spectrum antibiotics are necessary to treat eye shingles, meaning the antibiotic agents need to target many types of bacteria. According to the Wills Eye Manual, erythromycin ointment is effective for many eye symptoms of herpes zoster ophthalmicus. Erythromycin ointment is recommended to treat red eye, also called conjunctivitis, which can accompany eye shingles. Additionally, when inflammation occurs in the anterior part of the eye, called uveitis, erythromycin ointment can help. The recommended dosing is two times a day.
Bacitracin Ointment
The Massachusetts Eye and Ear Infirmary Manual of Ophthalmology recommends bacitracin for the typical skin lesions that accompany herpes zoster ophthalmicus. Typically, eye shingles present as skin lesions, or vesicles, that appear on just one side of the face, scalp and upper eyelid. Applying a broad-spectrum antibiotic ointment, such as bacitracin, helps fight any secondary infections that may occur with these often crusty and ulcerating lesions.
Fluoroquinolone Antibiotics
Fluoroquinolone antibiotics are a newer class of broad-spectrum antibiotics that include drugs such as Vigamox and Zymar. When eye shingles affect the cornea, coarse plaques with bulb-like endings can appear. Symptoms of decreased vision and redness of the eye are commonly associated with this corneal appearance. The Massachusetts Eye and Ear Infirmary Manual of Ophthalmology recommends using Vigamox or Zymar in these cases, with the dosing dependent on the size of the corneal disruption. Tapering the amount of drops used each day, versus abrupt discontinuation of the eye drops, is recommended for more effective treatment.
References
- American Academy of Family Physicians: Evaluation and Management of Herpes Zoster Ophthalmicus
- Wills Eye Manual; Douglas Rhee and Mark Pyfer; 1999
- The Massachusetts Eye and Ear Infirmary Illustrated Manual of Ophthalmology; Peter Kaiser, Neil Friedman and Roberto Pineda; 2004
