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Eye Herpes Guide - Causes, Symptoms, and Treatment

Ocular Eye Herpes What is eye herpes?
Ocular (eye) herpes is usually caused by the herpes simplex type 1 virus (HSV-1), the same virus that causes cold sores on the lips and mouth. In most people, the virus stays dormant, or recurs only around the mouth, but in some, the virus is reactivated and migrates down the nerve to one or both eyes. Doctors still do not completely understand this process or why it only affects certain individuals.

More rarely, ocular herpes can be a complication of shingles, which is a reactivation of the Varicella zoster virus (the virus that causes chicken pox, which is also a member of the herpes family).

Signs and symptoms
Symptoms will depend on the severity and depth of the eye infection, but may include:

  • Red, inflamed eye and tenderness
  • Swelling
  • Tearing, watery eye
  • Blurry vision
  • Sores
  • Scratchy or foreign body sensation
  • Light sensitivity

Different presentations of the disease
In most people, eye herpes will only affect the topmost layer of the cornea, called the epithelium. In others, the infection will penetrate deeper and can cause more serious problems, possibly even blindness.
  • Epithelial Keratitis
    This is the most common presentation of eye herpes. Only the epithelium (top layer) of the cornea is affected by the virus, resulting in distinct, dendritic (branched) ulcers which can be seen by the doctor during a slit lamp examination. This condition requires treatment but usually heals without scarring.

  • Stromal Keratitis
    The infection penetrates into the deeper layers of the cornea, called the stroma. Doctors are not sure why this damage occurs in only some individuals, but suspect it is either a result of viral replication in the stroma, or the immune system's response to the virus. Stromal keratitis can lead to scarring and loss of vision or blindness.

  • Iridocyclitis
    The iris and ciliary body become inflamed. This presentation is characterized by extreme sensitivity to light.

  • Herpes Retinitis
    The viral infection affects the retina (the light-sensitive tissue that lines the back of the eye), causing acute retinal necrosis. This condition is very serious, vision loss and possibly blindness, but is generally only seen in individuals with a compromised immune system.

The type of treatment depends on the severity and depth of the infection. If the infection is only in the epithelium, anti-viral medication will be prescribed in the form of eye drops, ointment, or oral pills. The doctor may also scrape away the infected eye tissue using a cotton swab or a special spatula instrument.

If the infection is in the stroma, steroid drops may be used to decrease inflammation and promote healing. However, steroids can suppress the body's immune response, and in some people may aggravate the condition, leading to future flare-ups.

If the cornea has become scarred beyond repair, a corneal transplant may be necessary to restore vision.

If you believe you may have ocular herpes, you should see your eye doctor as soon as possible to begin treatment and prevent scaring and vision problems.

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