Ocular herpes: definition, causes, symptoms, diagnosis and treatment

By Cristiano Antonino On May 9, 2023

Ocular herpes or more commonly known as eye herpes is an infection caused by the action of the Herpes Simplex virus

Usually, it is a nuisance that does not have negative consequences, if the correct therapy is followed to eliminate the virus.

In some cases, however, the infection can have complications, for example leaving scars on the corneal surface or, in the most serious cases, compromising vision.

To prevent this disorder, an eye examination is necessary to immediately implement a therapy capable of fighting the infection.

Causes

Herpes of the eye, as mentioned above, is determined by an infection caused mainly by the herpes simplex virus type 1.

The infection can affect people of any age and can be transmitted in several ways:

due to contact with a person affected by cold, ocular or, in rare cases, genital herpes;
by self-contamination, i.e. by touching or rubbing a herpetic lesion in the contagious phase;
in case of reactivation of the virus. People who have been infected in the past are more likely to get the virus again. Herpes tends to recur in periods of strong psychological stress, due to any hormonal alterations, for example, during pregnancy or after excessive exposure to sunlight.

Symptoms of eye herpes

The symptoms of ocular herpes resemble those of viral infectious conjunctivitis, namely:

eye pain;
photophobia;
blurred vision;
Red eyes;
abundant tearing.

Types of ocular herpes

There are different types of ocular herpes and this depends on the severity of the eye infection.

Below we list the most common:

Herpes keratitis, is among the most common and affects the superficial layer of the cornea. This discomfort usually resolves without leaving scars or lesions on the corneal surface.
Stromal keratitis, in this case the infection arises from herpes simplex, which goes deep into the central layer of the corneal membrane. Compared to the one mentioned above, the stremal is very dangerous, in fact, if not treated well it can lead to scarring of the cornea and vision problems.
Retinitis, this happens when the infection affects the retina or the innermost lining of the eye. This ocular herpes has the name of common herpetic retinitis. Only rarely can it lead to irreversible damage. The relapsing forms are much more dangerous and aggressive, in fact they can cause deep corneal ulcers, permanent scars and also in this case alteration and loss of vision.
Iridocyclitis is an infection caused by herpes simplex. It affects the iris and the ciliary bodies, internal structures of the eye, which can become inflamed causing hypersensitivity to light, but also blurring of vision and severe pain in the eyes.

How to prevent eye herpes

To avoid the symptoms of ocular herpes, you can try to prevent the infection in the following ways:

the infection occurs mainly through direct contact between the skin and the fluid from the vesicles. Passage between carriers and healthy people must be avoided;
transmission of the pathogen during the latent phase is rarer. However, many infections occur without any apparent prerequisite. This means that the carriers have neglected the first symptoms and have not avoided contact with other people;
limit the exchange of personal items such as soap, towels, toothbrushes, razors, etc;
it is possible that susceptibility to herpes viruses is genetically determined. If this were the case, prevention would acquire less decisive importance.

Diagnosis

It starts from the medical examination and consequently from a medical history to trace and diagnose an ocular herpes infection.

The doctor will look for any past herpes infections and immediately after will proceed with a physical examination looking for typical signs of herpes and, if present, will analyze the depth of the damage.

How is the patient’s eye examined? Typically, your doctor will use an ophthalmoscope, an instrument used to examine the deeper part of the eye, the optic nerve, and blood vessels.

To observe the internal ocular structures in detail, however, the slit lamp will be used, an instrument consisting of a light source and a magnifying glass, which is used to identify any corneal abrasions or ulcers.

The specialist will be able to take a sample from the conjunctiva or from the ocular secretion for a subsequent investigation of the cells and in this way will be able to confirm or not the presence of the infectious agent.

How to cure eye herpes

In the most serious forms, i.e. with the involvement of the corneal stroma, the use of specific eye drops is needed.

As mentioned above, in most cases the Herpes Simplex infection does not cause serious consequences for the patient’s health, in this case for his sight.

In fact, ocular herpes can be easily eradicated using eye drops or ophthalmic ointments with antiviral action.

Only if necessary, in the presence of a serious infection, the doctor will prescribe the use of oral antiviral drugs.

It is important to avoid wearing contact lenses for the duration of therapy.

Drugs and surgery

The most suitable drug for the treatment of ocular herpes is Ganciclovir: the dosage (dosage) involves instilling the drug in the form of eye drops 5 times a day, until the corneal ulcer subsides.

To prevent a bacterial infection, your doctor may advise you to use prophylactic antibiotic eye drops.

In extremis, if the therapies indicated above do not lead to good results, i.e. to fight and eradicate the virus, and the infection has left scars, then we will proceed to surgery with a cornea transplant to protect the patient’s vision.

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