Hutchinsons Sign and Ophthalmic (Eye) Shingles

Shingles, known medically as herpes zoster, is a viral disease. It’s caused by the same virus responsible for chickenpox, the varicella-zoster virus.

Most people who haven’t received the chickenpox vaccine have gotten the varicella-zoster virus. This usually happens in childhood. Even after you’ve recovered from chickenpox, the virus remains dormant in your nervous system and can cause shingles decades later.

Shingles usually gives you a very painful rash on your skin. In some cases, it can appear around and even inside your eye. This is called ophthalmic shingles, also known as herpes zoster ophthalmicus. This happens in about 8% to 20% of all shingles cases.

There is another symptom of ophthalmic shingles that often appears before the rash spreads into your eye. It’s called Hutchinson’s sign. This is a vesicular rash that usually starts near the tip of your nose.

Let’s talk about the connection between ophthalmic shingles and Hutchinson’s sign, what it looks like, and what to do if you suspect you have Hutchinson’s sign on your nose.

Causes of Hutchinson’s sign in ophthalmic shingles

Ophthalmic shingles occurs when the varicella-zoster virus reactivates in your trigeminal nerve, specifically at its ophthalmic branch. This nerve has three branches that extend to different parts of your face, and the ophthalmic branch is responsible for conveying sensory information from your:

• scalp
• forehead
• upper parts of the sinuses
• upper eyelids
eyes
• bridge and tip of the nose

Because this nerve extends to the tip of your nose, reactivation of the varicella-zoster virus can sometimes start there. The virus then may spread to one side of your nose, one of your eyes and its upper eyelid, forehead, and sometimes scalp.

Symptoms of Hutchinson’s sign in ophthalmic shingles

If you have Hutchinson’s sign, you can experience:

• vesicles (small blisters) or pustules (small bumps similar to pimples) at the tip of your nose
• burning or shooting sensation in the rash area
• occasional “pins and needles” sensation (paresthesia) in the rash area
• fever
• fatigue
• headache
• flu- like symptoms

Your rash may start spreading from your nose toward your forehead and one of your eyes. It’s important to speak with a doctor as soon as possible to reduce the risk of it getting into an eye.

If shingles has spread into an eye, you may have the following additional symptoms:

• burning or throbbing pain in your eye
• redness around and on the eye
• watery eye
• eye irritation
• blurry vision
• extreme sensitivity to light

Hutchinson’s sign pictures

Hutchinson’s sign can look differently depending on your skin tone, stage of the disease, and other factors. One common thing to look for is a painful vesicle or a “pimple” at the tip of your nose.

What to do if you think you have a vesicle on your nose

If you found a suspicious-looking bump at the tip of your nose, confirm that you have or had some other symptoms of shingles, especially pain in the area, flu- like symptoms, or fever.

If it looks like it may be shingles or if you’re unsure, contact a doctor or an urgent care facility immediately. If not treated on time or left untreated, ophthalmic shingles can cause serious complications in your eye, such as:

• conjunctivitis (pink eye)
• uveitis (inflammation of the middle layer of your eye)
• keratitis (inflammation of the top layer of your eye known as the cornea)
• glaucoma (condition that damages your optic nerve)
• blindness in the affected eye

Studies show that the presence of Hutchinson’s sign, compared to ophthalmic shingles without Hutchinson’s sign, quadruples your chances of developing severe eye complications.

How are ophthalmic shingles and Hutchinson’s signs treated?

Whether you have ophthalmic shingles with or without Hutchinson’s sign, treatment of the underlying viral infection is the same.

After confirming that you have ophthalmic shingles, a doctor will likely prescribe you antiviral therapy (acyclovir, valacyclovir, or famciclovir). These medications help shorten the length and severity of the shingles.

They are most effective if you start taking them as soon as possible after your shingles rash appears. The doctor will also recommend you treatment for pain.

Unless you’re immunocompromised or have other medical conditions, you won’t need to stay in the hospital to treat shingles. The prescribed antiviral medications usually come in tablet or liquid form and can be taken at home.

The treatment course typically lasts 7 days, but you should start feeling better sooner. But make sure to finish all the medication, or your shingles may return.

The doctor will likely refer you to an ophthalmologist (an eye doctor) for a consultation. An ophthalmologist will examine the affected eye to see if there is any damage from the virus. If needed, they will prescribe additional treatment to minimize the risk of complications.

It’s best to avoid contact with other people until your rash has crusted completely. If you decide to go out, ensure the affected part of your face is completely covered. Vesicles on your face contain the varicella-zoster virus that can cause chickenpox in people who haven’t had this disease or been vaccinated against it.

Other meanings of Hutchinson’s sign

The term “Hutchinson’s sign” can have other meanings unrelated to shingles:

• Hutchinson’s pupil: This term indicates that your pupil doesn’t contract in response to light. This may happen after a concussion or another brain injury.
• Hutchinson’s melanotic freckle (lentigo maligna melanoma): This is a rare type of melanoma (skin cancer) that usually affects older people.
• Hutchinson’s sign: Black pigmentation (usually a line) on your nail extending to the skin edge, which can also indicate a type of melanoma.
• Hutchinson’s triad: A combination of three symptoms common in congenital syphilis (a form of syphilis that babies acquire from their birth parent).

These terms have similar names because they are all named after Sir Jonathan Hutchinson, a British doctor who studied eye and skin diseases.

Takeaway

Hutchinson’s sign is an early indicator of ophthalmic (eye) shingles. It refers to painful vesicles or bumps at or near the tip of your nose. You may have other symptoms of shingles that accompany Hutchinson’s sign.

If you think you may have Hutchinson’s sign, speak with a doctor as soon as possible. If left untreated, the virus can spread into your eye and even cause blindness. Antiviral therapy is very effective if you take it as soon as possible after the beginning of your symptoms.

The term “Hutchinson’s sign” has other meanings, so make sure to clarify with a doctor what they refer to if you hear this term in relation to your symptoms.