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The development of complications depends on the severity of the infection and the location of the involved nerves. The most common chronic complication of shingles is a condition known as postherpetic neuralgia , defined as pain that persists more than 6 weeks after development of the rash. People with postherpetic neuralgia usually complain of the following sensations in the area of the affected nerve:

• Continuous burning or aching pain
• Intermittent sharp or lancinating (cutting or tearing) pain
• Allodynia - pain due to such benign stimuli as pressure from clothing, bedsheets or wind
• Paresthesias - numbness, tingling or prickling of the skin
• Anesthesia dolorosa - Severe pain occurring in an anesthetic area

After the age of 60, more that 40% of persons with herpes zoster will develop postherpetic neuralgia. Symptoms tend to diminish over time, with pain rarely persisting after 6-12 months.

Vulnerability to developing postherpetic neuralgia following shingles increases with age. The severity and duration of postherpetic neuralgia is also age-related, with longer and more severe postherpetic neuralgia episodes more frequently seen among older patients.

In addition to postherpetic neuralgia, other possible complications of shingles include:

• Ramsay Hunt syndrome (facial palsy, tinnitus, vertigo, deafness, loss of taste)
• Meningoencephalitis (headache, fever, photophobia, meningeal irritation, vomiting, nerve palsies, confusion). This is a very rare complication but people with a compromised immune system are at increased risk. Others with increased risk include those with shingles in a cranial nerve dermatome or those with disseminated rash.
• Myelitis (inflammation of the spinal cord)
• Paralysis (temporary)
• Dysphagia (difficulty swallowing)
• Nausea and vomiting
• Stomach upset
• Cardiac irregularities
• Weakness of the arms or legs
• Weakness of the diaphragm
• Secondary bacterial infection of affected sites

Complications of the Eye Due to Ophthalmic Zoster

Ophthalmic zoster is the term used when the varicella zoster virus affects the fifth (5th) cranial nerve, called the trigeminal nerve , in the face and head. The symptoms include a shingles rash that extends from the eye to the scalp. If left untreated, ophthalmic zoster can lead to inflammation, corneal ulcers/scarring, impaired vision, and even blindness.

Complications of ophthalmic zoster may include:

• Eyelid malfunction or loss
• Ptosis (drooping of the eyelid)
• Inflammation of various regions of the eye:
  • Keratitis (inflammation of the cornea)
  • Scleritis (inflammation of the outer portion of the eye)
  • Uveitis (inflammation of the (iris)
  • Varicella zoster retinitis (inflammation of the retina that often results in blindness)
• Secondary glaucoma
• Blindness
• Oculomotor palsies (paralysis of the eye muscles)
• Optic neuritis (inflammation of the optic nerve)
• Granulomatous cerebral angiitis - a condition that can cause stroke weeks or months after the attack