Critics rave about the pain of herpes zoster ophthalmicus! "Like fresh ground pepper ground into your eye while you sleep!" raves one. "A hot cheese grater on the forehead!" marvels another. "It would make a marvelous interrogation technique!" adds former Secretary of Defense Donald Rumsfeld.
Yes, it is all that -- and more! It has been almost a month since the first sign of infection. My forehead still looks mottled and purple and I still have a distressing variety of different types of pain. Nerves heal slowly, so this is not an illness for the impatient; the pain can linger for a long time. I am back at work, although I may have to reduce my hours somewhat. My ophthalmologist tells me that my cornea has healed up pretty well, with only minor scarring. I'm off the various antibiotic and steroid gels and drops. That's good news. The bad news is that the pain persists, and with it some hyper-sensitivity to light and difficulty focusing. So I'm wearing my sunglasses in front of the computer (yes, it is true; I wear my sunglasses at night). And I'm gone back to my regular doctor to try to come up with a plan to manage the pain.
On Sunday I tried Zostrix (capsaicin cream). Yes, the pain was bad enough that rubbing what is essentially hot chili sauce on my face seemed like a good idea! Remarkably, this really seemed to help. It works by inducing pain! That seems a little strange. The theory is that if you induce a steady pain, it causes depletion of something called "substance P." When the substance P goes down, the nerve loses some of its capacity to hurt you. It feels to me like I am distracting the nerve: while it is occupied handling a steady pain in my forehead, it stopped bothering me about my eye; the eye became less hyper-sensitive and started watering normally. Unfortunately, after a day of this my skin became raw and began to peel.
It also seemed impossible to prevent small quantities of the capsaicin from working their way into my eye. When this happened I would have to dash into the shower and drench my eye with Cetaphil cleanser. Whether this was because I couldn't keep from touching my face, or because some of the substance vaporizes or flakes off, I could not tell, but it doesn't really matter; it just does not seem quite practical to keep on my face next to my eye all day, and I can't sleep with it on, since I will inevitably rub it onto my pillow or a cover and then into my eye.
The eye does not water normally, so I'm dousing it with over-the-counter lubricating drops as recommended by my ophthamologist. My doctor has put me on a low dose of Elavil (amitryptiline, a tricyclic antidepressant) at night. This is supposed to help settle the damaged nerves. I also have some Vicodin to take as needed, although it does not seem to help very much.
Finally, I have set up an appointment to see an accupuncturist on Monday; he's got me taking some enzymes that are supposed to be helpful when dealing with viral infections. I try to keep an open mind with respect to alternative medicine: open, as they say, enough to let new ideas in, but not so wide open that my brain falls out. I think the accuncture is certainly not snake oil. If rubbing hot chilis into my forehead can help with the pain, sticking in some tiny needles will almost certainly help as well. I'm less confident about the enzymes, but I'll reserve judgement for now. Wish me luck!