What is herpes eye disease?

Herpes eye disease is a group of eye disorders caused by infection with the herpes simplex virus (HSV).

Herpes eye disease can affect many different parts of your eye. This includes your eyelids. Sometimes it affects the clear layer that covers the front of your eye (cornea). It can also affect the thin layer covering the inside of your eyelids and the white part of your eye (conjunctiva). Less often, the virus can damage your retina. This is the sensitive layer that lines the inner wall in the back part of your eye. Herpes eye disease can also affect the white part of your eye (sclera) or the colored part of your eye (iris). It is a major cause of blindness worldwide.

Herpes simplex virus is common. It generally infects a majority of adults and a slightly smaller percentage of children. Many people infected with the virus have no symptoms. Or they may have minor symptoms. These include getting cold sores now and then around the mouth. If the virus multiplies and becomes active, herpes eye disease symptoms may occur. These include eye redness, tearing, and even vision loss. These affected areas can become damaged.

What causes herpes eye disease?

Most of the time, infection with HSV type 1 (HSV1) causes herpes eye disease. HSV type 2 rarely causes eye symptoms. But it can cause genital herpes infections.

If you have herpes eye disease, HSV infected you at some point. But you likely did not have any symptoms when you were infected. Once the herpes virus is in your body, it stays there for life. It is often not active (dormant). But it can become active (reactivate) at any time.

Sometimes the virus will reactivate and start causing symptoms. This will often affect a certain set of nerves. Nerves to your eye may be affected. Then eye damage and herpes eye disease symptoms are likely. Most experts think herpes eye disease symptoms come from the virus reactivating in your body. They don’t think it comes from the direct infection, or from new contact with the herpes virus.

Experts are still not sure why HSV1 infection causes symptoms in some people but not in others. Some forms of HSV1 may cause herpes eye disease in a greater percentage of people. Variations in genes may also play a role. Having a problem with your immune system may raise your risk of getting herpes eye disease.

What are the symptoms of herpes eye disease?

Some possible symptoms include:

• Eye redness

• Eye pain

• Tearing

• More sensitivity to light

• Headache

• Feeling that something is in the eye

• Rash with blisters on the eyelids

• Painful sore on eyelid or eye surface

• Reduced vision linked to eye pain or eye redness

Repeated flare ups of herpes eye disease can scar your cornea over time. This scarring may be lifelong (permanent). This can lead to vision loss and sometimes blindness.

You may have only one flare up of the virus. But sometimes the virus reactivates and starts causing symptoms again. This is common. Risk factors that may increase your chances that the virus will flare up may include:

• Illness

• Fever

• Physical or emotional stress

• Too much exposure to heat or sunlight

• Eye injury

• Menstruation

• Injury

• A reaction to foods or medicines

Infection with HSV1 can also cause other symptoms outside your eye. This includes cold sores on your lips.

How is herpes eye disease diagnosed?

Your eye care provider (often an ophthalmologist) makes the diagnosis. This is done with a health history and a full eye exam. They may check your eye with a slit lamp microscope. This magnifies the surface and inside of your eye. Your provider will also likely place a dye on the surface of your eye. This lets them more closely examine your cornea.

Often you will not need any other testing. In rare cases, your provider might send a tiny bit of eye tissue to the lab to see if the virus is there.

How is herpes eye disease treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Possible treatments include:

• Antiviral medicines taken by mouth

• Antiviral ointment for your eyelids

• Antibiotic ointment for your eyelids (to prevent further infection by bacteria)

• Antiviral drops for your eyes

• Antibiotic drops for your eyes (to prevent further infection by bacteria)

• Steroid drops for your eyes (to reduce inflammation)

Most of these treatments are fairly short-term. You may also need to take antiviral medicine by mouth (orally) on a long-term basis. This is to help prevent future flare ups.

Some complications of herpes eye disease may need their own specific treatment.

What are possible complications of herpes eye disease?

Herpes eye disease can cause serious complications. A flare up can make your eye more likely to get other eye infections. This is why your eye care provider might treat you with antibiotics.

Sometimes this disease leaves lasting scars on your cornea. The cornea is often clear. But scarring makes it more cloudy (opaque). This can cause vision loss. If this is serious, you may need a corneal transplant (from a donor who has died) to restore your vision.

Herpes eye disease can also raise the pressure in your eye. You might need special eye drops. In rare cases, it can also cause infection of your brain and tissues around your brain. An antiviral medicine given through an intravenous (IV) line may be needed. Infection in newborns is often life-threatening. It can involve the brain and other organs.

Can herpes eye disease be prevented?

There is not much you can do to prevent infection with HSV1. Your eye care provider may put you on a medicine to reduce your chance of having the virus reactivate. Staying away from too much sunshine and stress may also reduce your chances of reactivation.

See your eye care provider at the first sign of symptoms. This can help reduce your chance of more complications.

When should I call my healthcare provider?

Call your healthcare provider if you think your herpes eye disease is active again. It is even more important to call right away if you have sudden and severe symptoms. These include severe eye pain, blurred vision, or eye discharge. You may need to see your eye care provider that same day.

Key points about herpes eye disease

• Herpes eye disease is a group of eye disorders caused by infection with the herpes simplex virus (HSV).

• Infection with HSV is very common. But most people infected with HSV don’t get herpes eye disease.

• It can affect many different parts of your eye.

• You might have only one episode of symptoms. Or symptoms may come back now and then as the virus reactivates.

• You might need to take antiviral and steroid medicines to treat an outbreak of the disease.

• It can sometimes cause serious problems. These include lasting scarring of your cornea and vision loss.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.