In addition to causing cold sores, the herpes simplex virus (HSV) can cause sores to appear on the eyes. When herpes symptoms affect the eyes, it is known as eye herpes, ocular herpes, or herpetic eye disease.
Eye herpes may be a cause for concern because it can have uncomfortable symptoms. In rare instances, eye herpes can affect the deeper layers of a person’s eyes and their vision.
In this article, we examine the types of herpes that can affect someone’s eye and the symptoms that may occur. We also look at the diagnosis of eye herpes and the treatment options.
Image credit: Powerfloh, 2013.
There are two major types of HSV:
Type 1
Herpes type 1 (HSV-1) commonly affects the face and is responsible for symptoms that include cold sores, which some people refer to as fever blisters.
According to the American Academy of Ophthalmology, HSV-1 is more likely than HSV-2 to cause eye infections.
Type 2
Herpes type 2 (HSV-2) is the sexually transmitted form of the virus. While this type mainly causes symptoms on the genitals, it can also affect the eyes.
A person will typically contract either form of the virus as a result of skin-to-skin contact with someone who already has the infection.
The virus often lays dormant in the nerve cells and can travel along the nerves to the eye upon activation.
Most people have contracted the virus at some point in their lives, but not everyone gets symptoms as a result.
When a person gets herpetic eye disease, they can experience a variety of symptoms. These can sometimes occur in both eyes, but they usually affect one eye more than the other.
Some of the symptoms depend on the affected part of the eye. Examples of these symptoms include:
- the feeling of something being in the eye
- headaches
- light sensitivity
- redness
- tearing
Sometimes, a person may also experience herpes sores on top of the eyelids. These may resemble a rash with blisters. The blisters will form crusts that usually heal within 3–7 days.
If the herpes virus affects the cornea, the inside of the eye, or the retina, a person may find that their vision becomes reduced.
Typically, eye herpes does not cause a lot of pain, even though a person’s eye may look painful.
The symptoms of an HSV infection affecting the eye may be very similar to those of the varicella-zoster virus, which causes chickenpox. However, a varicella-zoster infection is more likely to result in a rash with a distinctive pattern that occurs in only one eye.
Another condition that can have similar symptoms is pinkeye, which is also known as conjunctivitis.
Image credit: Burntfingers, 2015.
The herpes virus can spread via the nasal secretions or spit of a person with the infection. The likelihood may be higher when a person has a cold sore.
The virus within the secretions can then travel through the body’s nerves, which can include those in the eye.
In some cases, the virus enters the body and does not cause any problems or symptoms. Doctors describe this form of the virus as lying dormant.
Certain triggers can sometimes cause a dormant virus to start reproducing and cause eye irritation. Examples of these triggers include:
The herpes virus can be highly contagious. However, not everyone who contracts or comes into contact with the herpes virus will get eye herpes.
Ophthalmologists, or eye doctors, diagnose herpetic eye disease by taking the person’s medical history and asking them about their symptoms. They may ask the person when they first noticed their symptoms and what makes them worse or better.
The ophthalmologist will also conduct a physical examination of the eye. This examination will involve using a special microscope known as a slit lamp to visualize the eye’s surface and, potentially, the eyelid.
These professionals can usually diagnose eye herpes by looking at the sores. If the infection has reached the deeper layers of the eye, they will need to use special instruments to measure the eye pressure. They will also need to inspect the deeper eye layers whenever possible.
As part of the diagnosis, an ophthalmologist may also take a small cell sample known as a culture from a blistered area. They will then send this sample to a lab for testing for the presence of HSV.
For the most part, eye herpes affects the transparent front part of the eye. This condition is known as epithelial keratitis.
If eye herpes affects the deeper layers of the cornea, it is known as stromal keratitis. This condition is more concerning to eye doctors because it can cause scarring on the cornea, which can permanently affect a person’s vision.
No cure currently exists for herpetic eye disease. Instead, an eye doctor can prescribe medications that reduce the effects and symptoms of the condition. The location of eye herpes tends to determine the treatment options.
Eyelids
Doctors will prescribe topical ointments, such as an antiviral or antibiotic ointment, for a person to apply gently to their eyelids.
While antibiotic ointments will not treat the herpes infection, they will keep other bacteria from entering the open, blistering areas of the eyelid.
Outer eye layers
If the eye herpes only affects the outermost layers of the eye, a doctor may prescribe an antiviral eye drop or an oral antiviral medication, such as acyclovir (Zovirax). These help reduce the effects of the virus and could reduce the duration of symptoms.
Deeper eye layers
If the herpes virus has affected deeper layers of the eye, an eye doctor may prescribe antiviral eye drops and oral medications.
They may also prescribe steroid eye drops. These help reduce eye inflammation that could lead to increased eye pressure.
Prevention
As eye herpes can cause further infections, some doctors may recommend taking antiviral medicines on a regular basis to reduce the risk of getting eye herpes again.
Recurrent herpetic eye infections can lead to greater eye damage, which is why doctors want to prevent their recurrence.
Doctors may recommend that a person take an antiviral medication a few days before they have surgery so that they can prevent the stress of the surgery from triggering a herpes outbreak.
According to the American Academy of Ophthalmology, doctors diagnose about 50,000 new cases of eye herpes each year in the United States. While there is no cure for eye herpes, treatment can reduce the duration of symptoms.
If a person has recurrent eye infections or starts to experience vision loss, they should seek an appointment with an eye specialist for an assessment and advice on additional treatments.