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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 11305
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I am 64 years old; in April 2009, I had a shingles outbreak

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I am 64 years old; in April 2009, I had a shingles outbreak (my first) in the trigeminal nerve in the upper left quadrant of my face. My left eyelids swelled shut and I had some pain in my left eye; but most of the rash was on my forehead. Two different GPs examined my eye and said there was no sign of shingles, but when the eyelids opened again, my vision was blurry and an ophthalmologist diagnosed post-herpetic keratitis and has been treating it with Prednisolone 1%. In November, I developed severe pain in my left eye requiring Pregabalin to manage it; my ophthalmolgist diagnosed a flare-up of the keratitis, but the eye continued to hurt and my vision was blurry. In the absence of my own doctor, a different ophthalmologist diagnosed shingles in that eye and showed me a photograph of the filaments that had formed. He prescribed Valacyclovir (1500 mg/day) and the pain disappeared and I discontinued the Pregabalin. When my doctor discontinued the Valacyclovir in July, I developed blurry vision and raised pressure in my left eye after three weeks. I saw a different ophthalmologist since my doctor was away, he diagnised shingles and said that there was a new filament forming. He started the Valacylovir again and the eye started to improve. Today, when I was trying to talk to my GP about my shingles, he denied that I ever had shingles in my eye, or that Valacyclovir would be used to treat it although he used it for my original outbreak. He says that I am just being treated for keratitis and that the keratitis will continue to be a problem as "the virus" (not named) in my eye causes further inflammation and that this is why I am still taking the Valacyclovir. Can you tell why my GP would say this even though the ophthalmolgists have been saying it is shingles?
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Thank you for the excellent history.

Customer: replied 6 years ago.
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I have been sitting here thinking of some reason why your GP would say the things you indicated he said and the only thing I can come up with is because he is wrong. Time to get a new GP.

I have had a number of patients with recurrent/persistent HSV corneal stromal disease and keratitis who have taken antiviral meds PO for over a year.

As you know when there is reactivation of the epithelial disease there is usually live virus present, when there is keratitis it usually your body's reaction to the antigens left behind and possibly your own tissue that causes the problem. The epithelial disease should not be treated with steroid drops and the stromal disease should -- a difficult balancing act to be sure.

It sounds like you are in good hands with the ophthalmologists who are treating you. I wouldn't do anything different in my office.

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