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Painless shingles?
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Painless shingles?

Has anyone had or known of a case of shingles where there's no pain? I've been battling what was initially diagnosed as a herpes simplex keratitis and/or uveitis in my right eye for nearly 20 months. It's been treated with Valtrex (currently two grams a day), Viroptic, Trusopt, Alphagan and Lotemax. Meanwhile I've developed a cataract in the eye that has gotten bad enough so that I can't see much of anything besides blurry objects. I'm told the cataract can't be removed until the infection clears. The IOP has grumbled along in the high teens/lower 20s for several months, but occasionally it spikes into the 30s, as it did about 10 months ago, and I had to go on Diamox to bring it down. Stopped the Diamox in June and everything was "relatively" OK until it spiked again a few weeks ago up to 42. I went back on the Diamox and agreed to see another specialist. He took a different point of view from the three or four others I'd been seeing, in that he thought if it was herpes simplex that all these many months of antivirals would have taken care of it. Instead he suggested that I had and uncommon case of shingles/herpes zoster, uncommon in that there is no pain to it. He is going to wean me off the antivirals, beginning with the Viroptic, which I've stopped taking, and hopefully if the pressure stays low (now 22) I can get off the Diamox, plus he said to increase the Lotemax to every two hours. What I don't understand and didn't think to ask when I saw him yesterday is that zoster is a virus as well, so would not the antivirals still be appropriate to prescribe? Whe I asked the remedy assuming his diagnosis is correct he suggested that more steroids plus lubricating drops mightafford an answer. I fear that I may still experience shingles pain and/or problems in the other eye even though I'm told these are rare to nonexistent.  
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Shingles is, as you realize, usually painful, and also it doesn't last months even when untreated.  I'm hardly an expert on herpes and zoster (shingles) infections within the eye, but I can't explain your course on the basis of either type of infection.  It does seem reasonable to get you off the Valtrex at this point.  But I think you really need to direct your question to experts in ophthalmology or infectious diseases.  I think your eye doctor is proposing to stop the antivirals because he no longer thinks that viruses are playing any role in your condition.

Best.

Dr. Rockoff
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