in the US, essentially a larger-dose chickenpox vaccine) and the protein subunit Shingrix. Treatment Treatments for Ramsey Hunt Syndrome Type 2 are used to reduce further damage caused by the viral infection. These medications will not reverse any damage that has already occurred at the time that they are prescribed. Initial treatment with a corticosteroid such as prednisone and an antiviral drug such as acyclovir, valacyclovir or famciclovir for 5 to 7 days is standard; however, some studies have shown later damage to the facial nerve and recommend 21 days of antivirals. Studies indicate that treatment started within 72 hours of the onset of facial paralysis improves the chances of the patient experiencing significant recovery. Chances of recovery appear to decrease when treatment is delayed. Delay of treatment may result in permanent facial nerve paralysis. However, some studies demonstrate that even when steroids are started promptly, only 22% of all patients achieve full recovery of facial paralysis. Treatment apparently has no effect on the recovery of hearing loss. Meclizine, benzodiazepines such as diazepam, and vestibular therapy are sometimes used to treat the vertigo. During the acute recovery phase, the eye on the affected side of the face may not blink completely or at all and may not close tightly or at all when sleeping. If the eye is dry or feels irritated, this is a strong indication that the eye is not properly blinking or closing completely. Using artificial tears every 5 to 20 minutes while awake and protecting the eye while asleep are very important to maintaining the health of the eye. While asleep, applying overnight eye gel and using sensitive skin medical tape or an eye patch to keep the eye closed or using a moisture chamber can protect the eye. Taking these precautions is extremely important to preserve the health and functionality of the eye and prevent corneal abrasions and corneal ulcers. Nerve pain associated with Ramsay Hunt Syndrome may be extreme and centered in the ear, neck, cheek, jaw and face. This nerve pain may not respond well to standard pain treatments including NSAIDS and opioids. Medication specifically for nerve pain such as tricyclic antidepressants and gabapentin have been shown to be effective for the neuropathic pain and post-herpetic neuralgia common with RHS. Physical therapy, excessive movement or electrical stimulation practiced during the first year of recovery greatly increase the chances of long term complications, including