Shingles Signs, Symptoms, and Complications

While shingles is very rarely life-threatening, it can cause a painful rash anywhere on your body.

It usually appears as a single stripe of blisters that wraps around one side of your torso, or in some cases on one side of your face, neck, or around one eye.

The shingles blisters form over the course of three to five days, progressively dry out and crust over, and clear up in two to four weeks, according to the Centers for Disease Control and Prevention (CDC).

There is a vaccine available that works to prevent shingles for people ages 50 and older as well as for people ages 18 and older who are immunocompromised.

Per the CDC, these are some common symptoms of shingles:

Pain, itching, or tingling in the area where the rash will later develop
A rash that may begin a few days after this pain, itching, or tingling occurs
Fever
Headache
Chills
Upset stomach

The pain caused by shingles can be mild for some and intense for others.

Shingles blisters most often appear on one side of the torso, notes the CDC. It can also occur on one side of the face, or in or around the eye, or in rare cases, all over the body.

And in some instances, there is no pain, says Anne Louise Oaklander, MD, PhD, associate professor of neurology at Harvard Medical School and a neurologist at Massachusetts General Hospital in Boston.

In some instances, people who’ve had shingles may experience postherpetic neuralgia (PHN), in which pain persists well after the blisters go away. This happens because the shingles-damaged nerves continue to send pain signals to the brain.

In order to be diagnosed with postherpetic neuralgia, the pain has to last for 90 days or more after the blisters have cleared, according to a cohort study published in 2016.

Research varies, but postherpetic neuralgia has been estimated to affect from 5 to 20 percent of those with shingles.

There are several factors that can lead to postherpetic neuralgia. “Anything that depresses immunity can increase your risk,” says Dr. Oaklander.

She adds: “The severity of postherpetic neuralgia gradually eases over time in everyone, but the rate of resolution can vary. As you get older, your postherpetic neuralgia typically lasts longer and longer. Senior citizens, who are the most at risk for zoster, have substantial risk of postherpetic neuralgia lasting over a year, and sometimes for the rest of their lives.”

“If you have a lot of pain before the rash, it puts you at much higher risk for postherpetic neuralgia,” adds Joseph Safdieh, MD, professor of neurology at Weill Cornell Medicine in New York City.

Here are other factors that may raise your risk for PHN, according to a comprehensive review published in 2016:

Severe pain
Severe rash
Older age
Certain eye conditions
Lymphoma, leukemia, and other diseases that suppress the immune system
Autoimmune conditions, such as inflammatory bowel disease and rheumatoid arthritis
HIV
Diabetes
Recent trauma
Personality disorder

Yes. Shingles in or around the eye can be serious. This form of shingles is estimated to account for up to 20 percent of cases.

If you have the shingles rash around your eye, or even felt a shingles-like pain in the area, it's important to see an eye doctor right away.

Shingles in the eye tends to show up either inside the eyelid or on the surface of the eyeball. “The cornea is a common place to see shingles,” says Rebecca Taylor, MD, an ophthalmologist with Nashville Vision Associates in Tennessee. “It’s the clear domed tissue that you put contacts on.”

Shingles also often appears on the conjunctiva, she adds, which is the clear tissue that covers the whites of your eye and the inside of your eyelid.

There’s also a pattern in the rash to look out for, says Dr. Taylor. “If you have blisters on the tip of your nose, that’s a strong predictor of there being inflammation inside the eye.”

Prompt antiviral treatment can reduce the risk of chronic eye complications by 20 to 30 percent, according to research from 2020.

Steroid eye drops and lubricating tears may also be prescribed. You should also have regular eye exams in the months and years after the episode.

But in some cases, shingles in the eye can lead to permanent vision problems, including blindness.

Yes. In the months after an episode, some may be at a higher risk for having a stroke or a heart attack. In a research letter published in 2017, shingles was found to raise the risk of cardiovascular events, such as heart attacks and strokes, by 41 percent.
Those younger than 40, say the researchers, were at highest risk for a stroke.

According to the CDC, in very rare cases, shingles can also lead to:

Bacterial infections
Pneumonia
Hearing problems
Encephalitis, a virally induced inflammation of brain tissue
Death

Shingles can also lead to Ramsay Hunt syndrome, which occurs when a shingles outbreak affects the facial nerve near one of your ears.

Common symptoms of Ramsay Hunt syndrome include:

A painful red rash with fluid-filled blisters on, in, and around one ear
Facial weakness or paralysis on the same side as the affected ear

Less common symptoms include:

Ear pain
Hearing loss
Ringing in your ears (tinnitus)
Difficulty closing one eye
A sensation of spinning or moving (vertigo)
A change in taste perception or loss of taste
Dry mouth and eyes

Be sure to call your doctor if you experience any symptoms of Ramsay Hunt syndrome. Prompt treatment within three days of symptoms may help prevent complications including permanent hearing loss and facial weakness.

Shingles is caused by a viral infection and appears as blisters on your skin, usually in a band around one side of the torso. It may take up to four weeks for the blisters to heal, but in some cases there may be secondary illnesses that form. Those who are immunocompromised are at greater risk for postherpetic neuralgia, or severe pain that lasts up to three months after the blisters have disappeared.

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