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Herpes Eye Disease

What is herpes?

Herpes is a family of viruses with many different subtypes. Eye infections and mouth cold sores are most commonly caused by Herpes Simplex Virus (HSV) Type I.

What are the symptoms of herpes in the eye?

Herpes infections cause many ocular problems. A rash with vesicles or blisters can form on the eyelids which typically crusts over in 3-7 days. When the ocular surface is involved, the eye may develop redness, tearing, light sensitivity, foreign body sensation and even headache may occur. Decreased vision is possible.

Who gets herpes?

All age groups are affected by herpes. Neonatal herpetic infection can affect the eyes, central nervous system and other organs and can be life threatening. An initial ocular herpes infection typically occurs during childhood. Recurrences throughout life are possible.

Why do herpes infections recur?

The virus may remain dormant inside nerves near the face when the body's immune system deactivates but does not kill the virus. Reactivation of the virus is associated with systemic illness, stress and trauma.

Fig. 1 Slit lamp microscope view of herpes dendrite.

What parts of the eye are affected by herpes?

The herpes virus can affect almost any part of the eye. The eyelids can develop a rash of vesicles, the conjunctiva become inflamed and the cornea infected. The classic superficial cornea lesion (dendrite) and deep cornea infections can lead to permanent scarring and loss of vision. Iritis (inflammation of the uvea) and retinitis (inflammation of the retina) can also cause serious vision problems [See figures 1 and 2].

What is herpes zoster?

Herpes Zoster Virus (HZV) causes shingles and is the same virus that causes chicken pox. The virus remains dormant in the body after a chicken pox infection and can reactivate later. Herpes zoster infection involving the eye can appear very similar to a HSV infection. A rash usually develops on the forehead and around one eye and can eventually involve the conjunctiva, cornea, uvea and retina.

Fig. 2 Herpes dendrite stained with fluorescin dye.

How is herpes eye disease diagnosed?

The diagnosis of herpes eye disease is primarily made by clinical signs and symptoms. A culture may be obtained in questionable cases.

How is herpes eye disease treated?

Treatment of herpes eye disease depends upon the part of the eye that is involved. If the eyelid is the only site of involvement, treatment includes a topical antiviral ointment such as acyclovir. Oral acyclovir may also be used, especially for an initial infection. Antibiotic ointment may be used to prevent bacterial infection. If the conjunctiva or cornea is involved, topical antiviral drops (trifluridine) are typically utilized. Oral antivirals may be substituted for the topical therapy. If the uvea or deep layer of the cornea is involved, a topical anti-inflammatory steroid drop is typically prescribed.

Can herpes eye disease be prevented?

The herpes virus is contagious, but only few people who come in contact with the virus develop an ocular infection. Recurrence of ocular herpes infection is unfortunately common - upwards of 1/3 of those involved. Studies by the HEDS (Herpes Eye Disease Study Group) have shown that the rate of recurrence can be significantly reduced by oral acyclovir. The medication is taken daily and has very few side effects.