Herpes Eye Disease

What is herpes eye disease?

Herpes eye disease is a group of eye disorders that result from infection with the herpes simplex virus (HSV).

Herpes eye disease can affect many different parts of your eye. This includes your eyelids. Sometimes it affects your cornea, the clear layer that caps the front of your eye. Herpes eye disease can also affect your conjunctiva, the thin layer covering the inside of your eyelids and the white part of your eye. Less commonly, the virus can damage your retina, the sensitive layer that lines the inner wall in the back part of your eye. Rarely, herpes eye disease affects your sclera, the white part of your eye, or the iris, the colored part of your eye. It is a major cause of blindness worldwide.

Herpes simplex virus is common and generally infects a majority of adults and a slightly smaller percentage of children. However, most people infected with the virus either have no symptoms or minor symptoms. These include occasional cold sores around the mouth. People from a lower socioeconomic background are somewhat more likely to have the virus. If the virus multiplies and becomes active, symptoms of herpes eye disease, like eye redness, tearing, and even vision loss can happen. These affected areas can become damaged.

What causes herpes eye disease?

Most of the time, infection with HSV type 1 (HSV1) causes herpes eye disease. HSV type 2 rarely causes symptoms of the eye, but it can cause genital herpes infections.

If you have herpes eye disease, the herpes simplex virus infected you at some point. However, you probably did not experience any symptoms. Once the herpes virus is in your body, it stays there for life, usually in a dormant or sleeping state.

Sometimes the virus will reactivate and start causing symptoms, often along one set of nerves. If nerves to your eye are affected, eye damage and symptoms of herpes eye disease are likely. Most researchers think symptoms of herpes eye disease come from reactivation of the virus in your body, and not from the initial infection or new contact with the herpes virus.

Researchers are still not sure why HSV1 infection causes symptoms in some people but not in others. Certain strains of HSV1 may cause herpes eye disease in a greater percentage of people. Variations in genes may also play a role. (This is the genetic information passed from parents to children in the form of DNA.) Having a problem with your immune system might increase your risk of getting herpes eye disease too.

What are the symptoms of herpes eye disease?

Some possible symptoms of herpes eye disease include:

• Eye redness
• Eye pain
• Tearing
• Increased sensitivity to light
• Headache
• Sensation of something in the eye
• Rash with blisters on the eyelids
• Painful sore on eyelid or eye surface
• Reduced vision associated with eye pain or eye redness

Repeated flare-ups of herpes eye disease can eventually scar your cornea. This scarring may be permanent. This can lead to loss of vision and sometimes blindness.

You may only experience a single flare-up of the virus. However, sometimes the virus reactivates and starts causing symptoms again. This is fairly common. Certain factors may increase your chances that the virus will flare up, such as:

• Illness
• Stress
• Sunlight
• Eye injury
• Having your period
• Use of steroid medicines

Infection with HSV1 can also cause other symptoms outside your eye, like cold sores on your lips.

How is herpes eye disease diagnosed?

Your eye care provider (usually an ophthalmologist) makes the diagnosis with the help of a medical history and a thorough physical exam of your eye. He or she may look into your eye with a slit lamp microscope. This magnifies the surface and inside of your eye. Your provider will also probably place a dye into your eye that allows closer examination of your cornea.

Usually, you will not need any additional testing. In rare instances, your provider might send a tiny bit of eye tissue to the lab to test whether the virus is there.

How is herpes eye disease treated?

Your treatment for herpes eye disease may vary according to its severity, the part of your eye affected, and your response to previous therapy. Possible treatments include:

• Antiviral ointment for your eyelids
• Antibiotic ointment for your eyelids (to prevent infection by bacteria)
• Antiviral drops for your eyes
• Antiviral medicines taken by mouth
• Antibiotic drops for your eyes (to prevent further infection by bacteria)
• Steroid drops for your eyes (to reduce inflammation)

Most of these treatments are relatively short-term. You may also need to take oral antiviral medicine on a long-term basis to help prevent future flare-ups.

Some complications of herpes eye disease may need their own specific treatment.

What are the complications of herpes eye disease?

Herpes eye disease can cause significant complications. A flare-up can make your eye more vulnerable to other eye infections. This is why your provider might treat you with antibiotics.

Sometimes, herpes eye disease permanently scars your cornea. The cornea is usually transparent, but scarring makes it more opaque. This can cause vision loss. If this is significant, you might need a corneal transplant (from a cadaver donor) to restore your vision.

Herpes eye disease can also raise the pressure in your eye. This might need special eye drops. In rare instances, it can also cause infection of your brain and tissues around your brain. This might need an antiviral medicine given through an intravenous line. Infection in newborns is often life-threatening and can involve the brain and other organs.

Can herpes eye disease be prevented?

There is not much you can do to prevent infection with HSV1. Your healthcare provider may put you on a medicine to decrease your chance of having the virus reactivate. Avoiding excess sunshine and stress may also reduce your chances of reactivation.

You can help reduce your chance of complications if you see your eye care professional at the first sign of symptoms.

When should I call my healthcare provider?

Call your healthcare provider if you think your herpes eye disease is active again. It is especially important to call right away if you have sudden and severe symptoms, like severe eye pain, blurred vision, or discharge from your eye. You may need to see your ophthalmologist that same day.

Key points about herpes eye disease

Herpes eye disease is a group of eye disorders that result from infection with the herpes simplex virus (HSV).

• Infection with HSV is very common, but most people infected with HSV don’t get herpes eye disease.
• Herpes eye disease can affect many different parts of your eye.
• You might only have one episode of symptoms from herpes eye disease, or your symptoms might come back occasionally as the virus reactivates.
• You might need to take antiviral and steroid medicines to treat an outbreak of herpes eye disease.
• Herpes eye disease can sometimes cause serious complications. This includes permanent scarring of your cornea and vision loss.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.