What is ocular herpes?

Herpes viruses live around the nerve fibers of most adults and usually don’t cause problems. But when a person’s immune system is weakened, these viruses can multiply and cause symptoms.

When an ocular herpes outbreak occurs, a painful blistering rash can appear on the skin around your eye, forehead, and tip of your nose or also on the surface of your eye (the cornea).

Ocular herpes is worrisome because it can cause scarring, vision loss, and other long-term problems.

What are the types of ocular herpes?

Herpes Simplex Type I

Herpes simplex Type I is the same virus that causes cold sores on the lips and mouth. In the eye, it usually infects the cornea. This is known as herpes simplex keratitis. It typically affects the outermost corneal layer, called the epithelium, and heals without scarring.

In about 25 percent of cases, the virus infects the deeper corneal layer known as the stroma (called stromal keratitis). This is more serious because it can lead to scarring and vision loss. The virus can also infect the iris and surrounding tissues (iridocyclitis) as well as the retina, which is the inside lining of the back of the eye (herpes retinitis).

Varicella Zoster Virus

The Varicella-zoster virus is the same virus that causes chickenpox and shingles. When it affects the eye, it’s called herpes zoster ophthalmicus. Once you’ve had chickenpox, the virus stays dormant in your body and hides in nerve cells near your spinal cord. The virus can reactivate decades later anywhere on your body. The flare-up occurs in and around the eye in about ten to twenty percent of people with shingles.

What are the symptoms of ocular herpes?

Actually, the two types of herpetic eye disease have different symptoms, although both have eye pain in common. The symptoms help your doctor identify which virus is the culprit causing the outbreak.

Symptoms of herpes simplex type I (HSV-1)

• Pain in and around one eye only
• Eye redness
• The sensation of dirt or grit in the eye
• Tearing
• Pain when looking at a bright light
• Swelling or clouding of the cornea (known as keratitis)

Symptoms of herpes zoster eye infections

• Blisters around upper eyelid
• Headache and fever
• Redness, rash, or sores on the eyelids or around the eyes and forehead
• Sensitivity to touch
• Eye redness
• Blurred vision

What are the long-term side effects of ocular herpes?

Unfortunately, there can be long-term side effects following a herpes outbreak. Although the rash will fade after a few weeks, the pain can continue for weeks or months. This is due to nerve damage caused by the virus and it’s known as post-herpetic neuralgia.

Also, if herpes has infected your cornea, it can result in corneal ulcers, creating permanent scarring of the cornea that can lead to loss of vision. Lastly, your eye pressure can increase, leading to glaucoma.

Diagnosing ocular herpes infection of the eye

Your eye doctor can be diagnosed during a routine eye exam. Identifying which virus is the culprit depends on your symptoms. Your eye specialist may want to take a fluid sample from the blisters and send it to the lab to confirm which form of herpes is present.

Your eye specialist might also check the pressure inside your eye. In addition, your doctor might place fluorescein dye eye drops in your eye and examine it under ultraviolet light in order to check for damage to the surface of your cornea. Less commonly, herpes simplex virus may also infect the inside of the eye (Herpes Uveitis).

It’s possible for ocular herpes and conjunctivitis (commonly known as “pink eye”) to be confused, especially in the early stages. Both conditions can present with redness, tearing, and discomfort in the eye.

Who’s at risk for ocular herpes?

You’re at increased risk of getting ocular herpes if:

• You had chickenpox as a child (you can get herpes zoster ophthalmicus)
• You’re age 50 or older
• Your immune system is weakened by cancer, HIV, AIDS or any disease
• You’re on medications that weaken your immune system (say, chemotherapy or radiation for cancer or steroids following an organ transplant)
• You are under a lot of stress

Is ocular herpes contagious?

While the exact cause of a herpes virus outbreak is unknown, there seem to be stress-related factors associated with virus reactivation. These triggers include fever, sunburn, major surgical or dental procedures, and trauma. Herpetic eye disease is not sexually transmitted, and the virus is different from the one that causes genital herpes.

The herpes simplex virus enters the body through the nose or mouth and travels to the nerves, where it settles and can remain dormant for years. It’s possible that it may never wake up. However, once an initial outbreak occurs, untreated eye herpes has about a forty to fifty percent chance of returning.

The herpes zoster virus is transmitted through contact with someone who’s having an outbreak or through self-contact by touching a cold sore (fever blister) or lesion and spreading the virus to another part of your body. The virus is in its contagious stage when there are visible blisters present.

How to stop spreading ocular herpes

If you have a herpes zoster outbreak, it’s important to avoid close contact with anyone who’s never had chickenpox because you can transmit the virus to them and cause them to have a case of chickenpox. This is particularly dangerous for people with weakened immune systems, pregnant women, and children.

• Stay away from anyone who is pregnant or has a weakened immune system
• Cover your rash and avoid touching it
• Avoid scratching your rash
• Wash your hands frequently, especially after touching the rash

What is the treatment of ocular herpes?

Your treatment will depend on the severity of the infection and what part of the eye it affects.

• Although eye herpes has no cure, outbreak symptoms can be controlled with anti-viral medications. There are also anti-viral eye drops and topical antiviral gels that may be prescribed. Commonly prescribed oral antiviral medications include acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex) to help stop the virus from spreading, help the blisters heal faster and help relieve pain.
• Unfortunately, herpes infections can be very painful, even after several days of treatment, and after the eye starts looking better. Even though it may not seem like it, the medications are working and the pain will go away eventually. Usually, your rash should heal within one to three weeks, although sometimes it can take up to several months. Your doctor will want to monitor you throughout your treatment.
• It is very important that you take your anti-viral oral medication exactly as prescribed and for as long as your doctor recommends. Even if you start to look and feel better, if you stop taking the medicine too soon your infection can come back.
• If the herpes infection involves your cornea, your doctor might also prescribe steroid eye drops. Although corticosteroids help control swelling and prevent scarring, they can also increase your eye pressure, so your doctor will probably want to monitor you closely.
• It might be necessary to use an antibiotic eye drop along with a therapeutic contact lens in order to prevent a secondary bacterial infection from forming while the herpes is being treated.
• In the worst cases of ocular herpes involving severe permanent corneal scarring, corneal transplant surgery may be needed to restore vision.

How to prevent ocular herpes 

While there’s no prevention for the herpes simplex viral infection, you can get a vaccine to prevent the varicella-zoster virus (shingles). The Centers for Disease Control (CDC) recommends this vaccine for people 60 and older because it reduces your risk of shingles by more than fifty percent.

What’s more, the shingles vaccine can reduce your odds of having long-term nerve damage by more than 66 percent.

Why choose Assil Gaur Eye Institute for your eye care

The Assil Gaur Eye Institute is nationally recognized for its legacy of compassionate patient-centric care, its commitment to pioneering advances in ophthalmology, and its dedication to supporting the health and well-being not only of its patients but also of its community.

Dr. Kerry Assil has assembled a team of top ophthalmologists from around the country to offer our patients the highest quality of Specialist care within the comfort and familiarity of our Los Angeles offices. Our locations in Beverly Hills and Santa Monica allow patients to choose the clinic that’s most convenient to their home or office.

Please call (866) 945-2745 or make an appointment online.