Study shows long-term, low-dose antiviral treatment benefits patients with eye disease and pain from shingles

Medical Xpress / NYU Langone Health / Annual Meeting of the American Academy of Ophthalmology (AAO) ^ | Oct. 19, 2024 | Elisabeth J. Cohen, MD. et al

[ConservativeMind]

Long-term, low-dose antiviral treatment reduces the risk for potentially vision-damaging bouts of inflammation and infection, as well as pain, which occur when shingles affects the eye, according to research.

Shingles occurs when the varicella-zoster virus, which causes chickenpox in children, lies dormant for decades in nerve cells and then starts multiplying again for reasons unknown.

In about 8% of new shingles cases each year, the virus awakens in the nerve that supplies the forehead and eye, a condition called herpes zoster ophthalmicus, or HZO.

Shingles causes keratitis when it affects the cornea, and iritis when inside the eye, with both causing pain, redness, decreased vision, and sometimes glaucoma. Repeated flare-ups are associated with chronic eye disease, scarring, and vision loss.

The new research, part of the eight-year Zoster Eye Disease Study (ZEDS), shows that study participants treated for a year with a low dose of the inexpensive and safe antiviral drug valacyclovir (Valtrex) saw a 26% reduction in their risk of having new or worsening eye disease (keratitis or iritis) at 18 months.

Those treated were significantly less likely than those who got a placebo to have multiple disease flare-ups, with a 30% reduction at 12 months and a 28% reduction at 18 months.

In addition, participants on valacyclovir were found to have a shorter duration of pain at 18 months and needed significantly less neuropathic pain medication.

"Our results support changes in clinical practice," said Elisabeth J. Cohen, MD.

"Current standard treatment is a seven- to 10-day course of an antiviral, including the study drug valacyclovir," Dr. Cohen added.

Conducted in 95 medical centers in the U.S., Canada, and New Zealand, ZEDS enrolled 527 participants from November 2017 to January 2023 who were randomized to receive, double-masked, either 1,000 mg of valacyclovir daily or a placebo.

[ConservativeMind]

If you have had shingles of the eye, please consider getting a long-term prescription for valacyclovir (Valtrex). It is cheap and appears to provide protection against another bout of shingles, which likely will hit your eye worse. There is no good way to fix the eye damage, unfortunately.

Additionally, consider getting the shingles vaccine.

[ConservativeMind]

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[Valpal1]

I’ve had 3 friends get shingles in their optic nerve.

I got the Vax.