Eye herpes – You must know that!

General information

Eye herpes refers to an infection of the eye with herpes viruses. Different structures of the eye can be affected (nerves, cornea, etc.). The viruses are either viruses of the herpes simplex group (HSV), which in turn can be divided into type 1 and type 2, or varicella zoster viruses.

These viruses all belong to the herpes viruses, hence the name “eye herpes”. In addition to eye herpes, the herpes simplex viruses often cause herpes simplex keratitis, i.e. herpes-induced corneal inflammation. The term “eye herpes” therefore does not describe a uniform clinical picture, but is much more a kind of collective term for diseases of the eye caused by herpes viruses. Via droplet infection (breathing air) and smear infection, about 90% of the population will become infected with HSV-1 in the course of their lives and then carry the virus with them for the rest of their lives stored in the nerve cells. The “herpes” then appears symptomatically when the immune system is weakened.

How common is eye herpes?

Herpes of the eye (herpes corneae) is one of the most common corneal inflammations in adults. Depending on the depth of penetration, the following forms of herpes corneae can be distinguished:

  • Keratitis dendritica: This form of eye herpes exclusively affects the superficial epithelial layer of the cornea. The sensitivity of the cornea can be limited or completely eliminated.
  • Keratitis disciformis: The stroma (middle layer of the cornea between the epithelium and the endothelium) is also affected in this form of eye herpes, but the epithelial layer is intact. Disc-shaped infiltrates are visible in the stroma. – Endothelial keratitis/uveitis: In severe cases of eye herpes, viruses are infiltrated into the aqueous humour, which can then lead to swelling of the endothelial layer on the back of the epithelium and thus to glaucoma.

Since “eye herpes” does not represent a uniform clinical picture, it is also difficult to recognise it as such. Among ophthalmologists, it is often referred to as a “chameleon” because it can mimic many diseases. However, one can notice changes that indicate an infection and for which one should consult an ophthalmologist as soon as possible.

Indications may be blisters on the eyes, redness or other skin abnormalities. Inflammation of the cornea can cause a foreign body sensation and pain. However, pain is not present with every inflammation of the cornea.

Photophobia and impaired vision are also possible. With herpes zoster of the eyes, other complaints are also quite typical. These include sensitivity disorders in the area of the bridge and tip of the nose and the forehead, which are accompanied by severe pain.

Other areas of the skin can also be affected, as is typical for shingles. The skin is extremely painful and shows a diminished sensation of sensitivity, i.e. it feels numb but still shows the strongest pain. Typically, a blister-like, red rash is seen in the affected skin areas.

The skin infection is localised in a belt around the chest and shoulders. This is the origin of the name shingles. The disease is usually accompanied by fever and accompanied by general weakness.

Eye herpes can occur: Especially in the morning the eyes are often clogged. Blisters can form on the eyelids, which look similar to those of lip herpes. The cornea is often affected by eye herpes.

More rarely, there is also a herpes infection between the wall of the eyeball and the choroid. However, this infection is all the more serious because it affects the area that is necessary for the nutrition of the retina. For this reason there is a risk of blindness in this case.

The development of herpes in the eye varies greatly from person to person and a medical examination is absolutely necessary. Symptoms Eye herpes in short: Herpes Corneae shows the typical symptoms of an inflammation of the cornea (keratitis): the more often the attacks occur, the more likely scarring is to impair vision over time, and in the case of herpes diseases, more and more parts of the eye are affected. In severe cases, a corneal ulcer can develop, which can leave a hole in the cornea when it breaks open.

If the disease becomes chronic, it can cause further eye diseases. – Redness of the eyes,

  • Foreign body sensation when blinking,
  • Severe burning and itching and
  • Increased secretion of fluid from the eye. up to purulent secretion
  • Eye redness
  • Foreign body sensation Fremdkörpergefu
  • Photosensitivity
  • Visual impairment
  • (rarely) glued eyes
  • Burning, itching

The ophthalmologist will prescribe eye drops and/or eye ointments with virustatic agents such as :

  • Acyclovir,
  • Ganciclovir,
  • Trifluorothymidine,
  • Trifluridine and idoxuridine.

In the case of eye herpes, ordinary eye drops, so-called “whitening agents”, must never be used to treat the redness of the eyes, as these agents cause a poorer supply of fluid to the eye, which further aggravates the disease. Hygiene articles, such as towels and washcloths, should never be shared in the family, but the person affected should use disposable products if possible until the “herpes” has completely healed. Only the strictest hygiene can prevent a smear infection and thus a further spread.

If the eye herpes was also caused by another infection (by bacteria), antibiotics can be prescribed to treat the underlying disease. However, the antibiotics are ineffective against the herpes viruses themselves. There are ointments for the treatment of eye herpes.

Most of them contain antiviral substances such as Aciclovir or Valaciclovir. In the case of herpetic keratitis, such eye ointments are used for weeks. Depending on the type of herpes keratitis, topical glucocorticoids may also be applied.

However, this is strictly contraindicated in keratitis dendritica, a special form of eye herpes, as the clinical picture would worsen. Aciclovir ointments are also used in cases of eye herpes caused by zoster viruses. Ointments made from a zinc shaking mixture can also be used for rashes.

As described above, the herpes simplex virus type 1 is able to remain in its inactive form in the body for a lifetime after a single infection, which usually occurred at a young age. The virus then nests in the nerve cells, where it usually goes completely unnoticed – until a new outbreak of the disease occurs due to a combination of certain circumstances. It often happens that a cold or other illness that we have just gone through has weakened our immune system, which is then no longer able to keep the herpes virus under control in the nerve cells and the viruses can multiply and spread again.

Hormonal changes can also lead to eye herpes outbreaks, especially in women. However, the most common cause is usually an increased stress level, which puts an unhealthy strain on the entire body and then of course, in addition to the already strenuous meeting, the upcoming business trip or the big planned wedding day, leads to eye herpes and makes our lives more difficult. As already mentioned, the most common cause for a new outbreak of eye herpes is stress.

Therefore, it is important to avoid this if possible. It is therefore important to get enough sleep (around eight hours per night), a healthy, balanced diet and also to balance out the often stressful everyday activities, such as sports or other hobbies. During an acute outbreak, it is of course important to ensure that the viruses are not spread further.

Therefore, it is always important to use your own washcloths and towels, to keep your hands away from the affected area and not to come too close to other people in the vicinity with your face. The same of course applies to an outbreak of cold sores: people affected should always be extremely careful not to wipe their eyes with their fingers after touching the herpes blisters on their lips. In general, it should be avoided to scratch the blisters, as disturbing as they may be.

This can greatly reduce the risk of developing eye herpes. To prevent herpes zoster of the eyes there is also a live vaccine against varicella, which is one of the standard vaccinations for children. The vaccination is carried out as part of the U6 and U7 examination.

Infection with herpes simplex viruses usually occurs in the early childhood. The transmission is usually by smear or droplet infection and the initial infection usually proceeds without symptoms. However, the virus remains in humans for life and can lead to repeated outbreaks of disease if the immune system is weakened.

The initial infection with the varicella zoster virus also almost always occurs in childhood and then usually leads to the clinical picture of chickenpox – a typical childhood disease. This virus also remains in the body for life, but when reactivated it leads to an outbreak of shingles. In both cases the virus remains in nerves that supply the infected areas of the body.

Accordingly, direct infection of the eye region can always cause eye herpes, and care must therefore be taken during active herpes infection not to spread it to other parts of the body by scratching or rubbing the infected blisters. If a manifestation of the disease breaks out in the eye, you are also contagious for your fellow human beings. Therefore, contact with mucous membranes should not occur during the illness.

Also saliva or other body fluids such as tears should not reach other people. Herpetic rashes should not be touched, as the hands often have contact with mucous membranes or the eyes and can thus transmit viruses. The common use of towels should be avoided.

However, if the eye herpes is detected in time, it can be treated well and in any case the symptoms can be quickly combated so that consequential damage such as reduced vision rarely occurs. The term “eye herpes” does not describe a uniform clinical picture, but is much more a kind of collective term for diseases of the eye caused by herpes viruses. Therefore, the duration of the respective form of the disease or illness cannot be determined so precisely.

It depends on the exact type of inflammation and the response to therapy. Herpes keratitis must be treated for at least 2 to 4 weeks, depending on the course of the disease and the extent of its manifestation. However, it is difficult to estimate an exact duration, since “eye herpes”, as many ophthalmologists confirm, behaves like a chameleon of ophthalmology.

The course can be very individual. Recurrences are also possible. Since a herpes infection of the eye damages the integrity and defence of the cornea, it is more susceptible to microbial infections, which can additionally prolong the duration of the disease.

A herpes zoster of the eye, colloquially known as eye herpes, usually heals after 3 to 4 weeks. However, pain and discomfort can persist beyond this time. This is called post-herpetic neuralgia.

Early and good therapy is therefore very important, otherwise the symptoms may become chronic. Recurrences are also possible. The first appearance of the disease is often an infection of the superficial layer.

This usually heals quickly with appropriate treatment. However, since the herpes viruses remain in the organism, the disease can recur again and again. Among other things, this can lead to a new attack of eye herpes: In later episodes of eye herpes, the deeper corneal layers are always affected, which can lead to dense scarring on the cornea.

The cornea can then swell and become cloudy, which can lead to blindness of the affected eye. – External irritation,

  • Stress and
  • Infections

The incubation period of the various herpes diseases of the eye is very different. The herpes zoster of the eye shows an incubation period of about 7 to 18 days.

A reactivation is also possible in case of an already existing infection with Herpes Zoster virus. These viruses can remain mute in nerve structures for years and can be reactivated if the immune system is unfavourable, causing the disease to break out. The situation is similar with infections caused by Herpes simplex viruses of type 1 or 2.

A manifestation of the eyes usually occurs after an already existing infection with the virus. It is therefore difficult to specify an incubation period. Eye herpes can of course also occur in children.

The disease does not differ in any way from that of adults, only the therapy is a little more complicated, as cooperation is often not yet given in children and they are quickly rubbed with their hands in the burning eyes. So here special attention of the parents is required. Herpes viruses can be transmitted in babies already during pregnancy or during the birth process, but also after birth.

Transmission by the mother before or during birth can be prevented with timely antiviral medication. Newborns are often infected during normal family contact with the herpes virus. This transmission takes place through saliva contact or smear infection.

A manifestation of eye herpes can thus already be seen in babies and small children. Similar to adults, it manifests itself by blister-like rashes on the eyelids and complaints of the eyes, such as pain, a foreign body sensation or impaired vision. Babies may also develop a fever.

Particularly in the first 6 weeks of life, care should be taken to avoid infection with herpes viruses. If a herpes infection is known to the parents, they should definitely follow certain hygiene measures. It should be avoided to kiss the baby or to use common cutlery.

Also, no shared towels should be used. If the child has become infected, a quick visit to the doctor is necessary. The doctor can then treat the baby with antiviral medication.

This is important, as otherwise complications such as an infection of the central nervous system or scarring in the eye are possible. The activated herpes viruses form the familiar scabby incrustation on various parts of the body, but often on the lips (herpes labialis). However, the viruses can also infect the eye and all other parts of the body.

In the case of eye herpes (herpes corneae) the eyelids and cornea are often affected. In rare cases, the choroid of the eye, which is located further inwards, is also affected. Eye herpes (herpes corneae) is rarely the first site of infection with HSV1 or HSV2, but usually the spread of recurrent (recurrent) lip herpes (herpes labialis).