Eye herpes, also known as ocular herpes, is an infection of the eye by the herpes simplex virus (HSV). The most common type is called epithelial keratitis, and it affects the cornea, the clear front portion of your eye. In its mild form, eye herpes causes:
tearing of the cornea surface
HSV infection of the deeper, middle layers of the cornea, known as the stroma, can cause severe damage leading to vision loss and blindness. Eye herpes is the most common cause of blindness associated with cornea damage in the United States.
Both mild and severe eye herpes can be treated with antiviral medication.
Eye herpes is transmitted through contact with another person who is having an outbreak, or through self contact and contamination during an active herpes infection (such as a cold sore of the lip).
The exact cause of an outbreak is unknown, but stress-related factors such as fever, sunburn, major dental or surgical procedures and trauma are often associated with incidents.
Although symptoms usually present themselves in only one eye, the virus possibly could affect the other eye as well.
Eye herpes isn’t sexually transmitted, but is picked up from direct contact with the skin or fluids of a person with active HSV-1. Genital herpes is usually associated with type 2 HSV and is sexually transmitted.
It’s estimated that up to 90 percent of adults have been exposed to HSV by the age of 50.
The herpes simplex virus enters the body through the nose or mouth and travels into the nerves, where it may be inactive. The virus can remain dormant for years and may never wake up.
Typical symptoms of eye herpes include:
sensitivity to light
inflamed eyelids (blepharitis)
Swelling around the eyes
If you have symptoms of eye herpes, see an ophthalmologist or an optometrist, both doctors who specialize in eye health.
Your doctor will do a thorough eye exam to evaluate your vision, sensitivity to light, and eye movements. They’ll put eye drops in your eyes to dilate (widen) the iris too.
Your doctor may perform a fluorescein eye stain test. During the test, your doctor will use an eye drop to place a dark orange dye, called fluorescein, onto the outer surface of your eye. Your doctor will look at the way the dye stains your eye to help them identify any problems with your cornea, such as scarring from the HSV infection.
Your doctor may take a sample of cells from your eye surface to check for HSV if the diagnosis is unclear.
If your doctor determines you have eye herpes, you’ll immediately start taking prescription antiviral medication. The treatment differs somewhat depending on whether you have epithelial keratitis (the milder form) or stromal keratitis (the more damaging form).
Epithelial keratitis treatment
HSV infection in the surface layer of the cornea usually subsides on its own within a few weeks. Promptly taken antiviral medication can help minimize cornea damage and vision loss. Your doctor will recommend antiviral eye drops or ointment, or oral antiviral drugs.
A common treatment is the oral medication acyclovir (Zovirax).
Stromal keratitis treatment
This type of HSV infection attacks the deeper, middle layers of the cornea, called the stroma. Stromal keratitis is more likely to result in corneal scarring and loss of vision. In addition to antiviral therapy, taking steroid (anti-inflammatory) eye drops helps to reduce swelling in the stroma.
Recurrence of the condition
After a first bout of eye herpes, about 20 percent of people will have an additional outbreak of eye herpes in the following year. After multiple recurrences, your doctor may recommend taking antiviral medication daily.
Although eye herpes is not curable, you can minimize damage to your eyesight during outbreaks. At the first sign of symptoms, call your doctor. The sooner you get treated, the less your chances of significant damage to your cornea.