Ocular Herpes: What You Need to Know

Did you know that herpes may also occur on the eyes as ocular herpes (eye herpes)? 

This is because herpes is not just limited to the usual places blisters can be found: lips and the genital area. 

Although having eye herpes is a fairly rare infection, your chances of acquiring the infection increases by at least tenfold if you already have the herpes virus in your system.

So wash your hands thoroughly and avoid touching your eyes. Self-contamination is possible so proper hygiene is a must.

Ocular herpes can recur too especially when a person with the virus is exposed to extreme environmental conditions. Stress is also a factor that causes outbreaks to keep coming back.

But not to worry. The good news is that there are ways for you to prevent it from happening! 

The Important Points

Two herpes viruses can cause ocular herpes. Herpes Simplex Virus 1 (HSV 1), which causes cold sores, and the Varizella Zoster Virus (VZV), which causes chicken pox or shingles. In the eyes, HSV 1 causes herpes simplex keratitis while VZV causes herpes zoster ophthalmicus. However, both are still considered as eye herpes.

Eye Herpes causes corneal inflammation and scarring. Unlike the other more common infections of the eye, herpes have higher chances of causing corneal scarring. 

Eye Herpes can cause blindness. Statistics have shown that in the United States, the infection is the most common cause of corneal blindness, and if not treated on a timely manner, may even cause eye damage.

The infection is acquired through direct contact. Because eye herpes is essentially caused by either HSV or VZV, direct contact with an active sore can cause the infection.

Self-contamination is possible. Self-contamination is possible especially if you have an active infection. This can be done through rubbing of the eyes.

Treatment is a combination of oral and topical antivirals. Oral and topical antivirals are used together to treat the infection, sometimes given in conjunction with steroids. For more information on the correct treatment, be sure to consult with your physician.

Because a herpes virus causes it, there is no cure. Although there are several treatments available for episodes of the infection, there is currently no cure for the virus. However, there is a long-term antiviral pill treatment available that could make the recurrence of the infection lessen.

There is more than one form that you can get. The form of eye herpes that you can get is dependent on which part of the eye is infected during an outbreak.

Symptoms of Ocular Herpes

Ocular Herpes Symptoms
  1. Pain. Ocular pain due to herpes may be burning, dull, gritty, sharp, or shooting. It may also be perceived as a feeling of having something in your eye. Pain is most often associated with other symptoms like headache or migraine. Pain may also occur only on one eye or both.
  2. Redness, rash, and sores. Ocular redness may be due to a number of diseases as it is one of the cardinal signs of having an eye infection. It is most commonly caused by the dilation (enlargement) of the eye’s blood vessels, and indicates either inflammation or excessive straining of the eyes. Sores during an outbreak usually occur around the eyelids and the forehead. 
  3. Swelling and cloudiness of the cornea. Eye herpes, especially those that can lead to corneal scarring (mentioned here later), can cause swelling and cloudiness of the cornea which could impede with vision, and in worst case scenarios even cause blindness.
  4. Tearing. The eyes water as a form of defense against particles that enter it. In the case of the infection, watering or tearing occur more frequently due to irritation of the lacrimal glands (tear glands).
  5. Light Sensitivity. The eyes become sensitive to light in the onset of the infection, especially with bright lights and direct sunlight. These could cause more tearing and pain to the affected portions of the eyes.
  6. Discharge. Eye discharge during the infection is usually watery but slightly thicker than tears.

Forms (Types) of Ocular Herpes

As previously mentioned, an eye herpes infection can occur in four types, depending on which area of the eye the virus infects. Here are the four types:

  • Herpes keratitis. Herpes keratitis is probably the most common form of the infection. In this form, the infection is generally confined to the cornea’s uppermost layer. It is able to heal without any scarring.
  • Stromal Keratitis. Stromal keratitis is a form wherein the infection of the eyes goes into the cornea’s deeper layers. Stromal keratitis can cause scarring after it’s healed, and can even cause loss of vision and in severe cases even blindness. The occurrence is rare, and is named by the NEI (National Eye Institute) as the foremost cause of corneal scarring that could eventually lead to blindness.
  • Iridocyclitis. The iridocyclitis is probably the most serious form of the infection wherein the iris, together with its surrounding tissues, are inflamed, which could then cause blurred vision, red eyes, pain, and sensitivity to light. Iridocyclitis mainly affects the majority of the eye’s frontal portions.
  • Herpes retinitis. Herpes retinitis is the manifestation when the infection occurs in the area of the retina.

Treatment Options

Treatment for ocular herpes is completely dependent on what part of the eye suffers the infection. For this reason, always consult with a health professional before taking any medication lest you aggravate your infection. Here are some of the common ways to treat ocular herpes:

  1. Antiviral eye drops, oral antiviral pills, or ointments. These are more commonly used when the herpes infection is corneal and only superficial. Remember not to use contact lenses while on medication as they may only worsen your infection.
  2. Debridement. This is done by an ophthalmologist (eye doctor), and is done by scraping off the infected epithelial cells by using a cotton swab or a specialized corneal instrument. The use of a patch or soft contact lens is sometimes used to help with the healing of the debrided part.
  3. Steroid Drops. Steroid drops are used to help minimize eye inflammation and prevent scarring of the cornea, especially if the infection is located in the deeper layers of the cornea. However, the used of steroid drops can decrease the efficiency of the eye’s own immune response. So before using, be sure to ask your physician.
  4. Surgery. Surgery is only indicated in worst cases of ocular herpes, like when the infection caused scarring of the cornea and other treatments have failed to clear it.

What To Do Next?

If you feel like you've acquired a case of ocular herpes but are still unsure of whether it really is herpes or not:

  • The best way to be sure is to approach your physician and tell him or her, your concerns. They will be able to either confirm or deny your suspicions, and give you the correct medications for the condition that you already have.
  • On the other hand, if you have already confirmed that you have a case of ocular herpes and have spoken to your physician, then the best thing to do is to conform to the treatment plan that was presented to you as to prevent aggravating your infection.

Ocular herpes is a recurrent infection, and it has a general likelihood to recur when you are facing extreme environments. This is because the virus that causes the infection is able to remain dormant (sleeping) in the body’s nerves.

As with any infection that occurs, the answer to decreasing the number of chances that the infection will recur is to manage the infection properly. A good way to start is by always keeping your hands clean and to avoid touching your eye area as much as possible.

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