Shingles complications threatens patient's vision and life

Bill Rowcliffe says he owes not just his vision, but also his life to his ophthalmology team at UC Irvine. Last summer, doctors at the UCI Health Gavin Herbert Eye Institute found an inflammation in his optic nerve that required a trip to the emergency room.

Rowcliffe ultimately spent six days in the hospital, his care coordinated by specialists in ophthalmology, neurology and infectious diseases. “The ophthalmology team did a great job treating him while he was at the hospital,” says Rowcliffe’s wife, Clayre Petray. “I think they’re the reason he’s alive today.” In spring 2024, he developed a zoster infection, commonly known as shingles. Caused by the same virus as chickenpox, shingles is a painful red rash that occurs most often in older adults. When the rash appears on the face, as it did with Rowcliffe, it can cause inflammation in the cornea and other areas of the eye, potentially leading to irreversible vision loss. He sought care at the eye institute, where he was prescribed antivirals and eye drops. They can help prevent vision loss in shingles patients — as long as the inflammation is treated before causing permanent damage to the cornea.

“Shingles on the face is considered an eye emergency because it can lead to serious complications if not treated urgently,” says UCI Health neuro-ophthalmologist Dr. Samuel J. Spiegel. “But after he was seen and treated for this rare presentation of shingles, the patient had an extremely uncommon neurological side effect caused by the disease.” Rowcliffe thought he was on the mend until a few weeks later when he returned to the eye institute complaining of blurred vision. Cornea specialist Dr. Marjan Farid examined the optic nerve in his left eye and immediately called Spiegel. They huddled outside the exam room to confirm their diagnosis: post-shingles inflammation was causing fluid buildup on the optic nerve, which could lead to vision loss and even blindness. They sent him straight to the emergency room at UCI Medical Center in Orange. Farid and Spiegel continued managing Rowcliffe’s care after he was admitted to the hospital, coordinating with neurology, infectious disease and emergency medicine specialists. Cases of post-shingles inflammation of the optic nerve are so rare that there is no widely accepted best practice for treatment. Farid and Spiegel consulted across departments and even other academic medical institutions before deciding to proceed with high-dose intravenous steroids in addition to anti-viral treatment, which reversed the inflammation. 

“My overall experience — other than it being the worst thing that’s ever happened to me — is that UCI Health has a great team,” says Rowcliffe. With ongoing eye care, his vision continued to improve. He has resumed his regular routine: driving, reading and playing pickleball. “I can see to make contact with the ball again on the pickleball court,” says Rowcliffe, whose vision is back to 20/30. “I’m very grateful to my all doctors, especially my ophthalmologists.”