The following article provides information about ocular herpes (herpes on the eye), which usually occurs as corneal inflammation (herpes corneae). Causes, diagnosis, treatment and prevention of herpes disease of the eye are explained below.
What is ocular herpes?
Ocular herpes is an inflammation of one or both eyes. It usually affects the cornea (herpes corneae), and may also affect the conjunctiva or eyelids. It is an infectious disease of the eye.
Causes
Herpes infection of the eye is caused by herpes virus (herpes simplex) type 1 or 2. The causative agent is therefore the same as for the more familiar herpes cold sores. Often – but not always – ocular herpes is a spreading lip herpes infection (herpes labiae). Infection of the cornea with herpes viruses is one of the most common causes of corneal inflammation in adults. There is hardly any effective protection against infection with herpes viruses. Herpes viruses are transmitted through the respiratory air (droplet infection) or direct physical contact (smear infection). An estimated 90 percent of the population have already been affected by a herpes infection and carry the virus with them from then on. Inflammation with herpes viruses can subsequently occur again and again, especially if the immune system is weakened – for example due to other diseases, an unhealthy lifestyle, hormonal changes or stress. Such inflammation usually occurs on the lips (labial herpes, herpes labialis), but it can also manifest itself on other parts of the body – such as the eye.
Symptoms, complaints, and signs
A herpes infection in the eye can manifest itself differently, depending on which parts of the eye are affected. Not all of the symptoms mentioned need occur at the same time. However, the appearance of one or more vesicles on the eyelid is typical. These correspond to the characteristic cold sores in cold sores. However, blisters are not always found on the edge of the eyelid in cases of ocular herpes. Often there is redness of the affected eye. It also itches, burns and watering.
- Corneal inflammation due to herpes viruses: redness of the affected eye, foreign body sensation (“like sand in the eye”), sensitivity to light, vision deterioration, burning or itching, tearing and oozing of the eye; if the eyelids are affected, herpes blisters appear here as on the lips.
- Conjunctivitis caused by herpes viruses: redness and swelling of the conjunctiva, itching, burning, sticky eyes in the morning, oozing and tearing of the eye.
The patient often complains of a foreign body sensation in the affected eyes. Usually only one eye is affected, but sometimes both. Eye herpes on the eyelids is not dangerous and easily treatable. In rare cases, the conjunctiva is affected and conjunctivitis develops. However, this quickly heals on its own. Even if the cornea is affected, treatment is usually uncomplicated. However, if an infection of the cornea is not treated, scarring can develop there, leading to clouding of the lens and, under certain circumstances, to a severe reduction in vision. An infection of the choroid, however, is very dangerous. If the infected choroid is not treated intensively, blindness may result. Herpes viruses reside in the body for a lifetime and become active under certain conditions. Therefore, ocular herpes can recur during stress or in the context of other diseases.
Diagnosis and course
Immediate evaluation by an ophthalmologist is essential if any of the listed symptoms are present. Only a specialist can determine what the disease is. With early drug treatment, herpes infection of the eye can be contained well and without complications. A doctor will swab the eye to determine whether or not a herpes infection is present and initiate treatment based on this result. When a herpes infection first occurs, often only the upper layer of the skin is affected. As a result, the chances of cure are good with rapid treatment. To date, however, there are no drugs that can completely kill viruses. Since the herpes viruses therefore remain in the body permanently, a new bout of infection can occur at any time if the immune system is irritated or weakened.The more frequent corneal inflammation caused by herpes viruses, the more serious the infection usually becomes: deeper tissue layers are also affected and scarring of the cornea can occur, limiting vision. If the infection becomes chronic, it can result in other diseases of the eye, such as cataracts.
Complications
Ocular herpes may be associated with blisters and redness on the eyes. If the cornea is inflamed, the affected person may experience pain. In addition, there may be a foreign body sensation in the eye. Restricted vision and photophobia are also possible. Ocular herpes can also affect other areas of the body. Sensory disturbances may occur on the forehead, tip of the nose, and bridge of the nose, which are associated with severe pain. The skin may ache and may show decreased sensation of sensitivity, meaning it feels numb but still shows severe pain. Ocular herpes may also be accompanied by fever and general weakness. Eye herpes can come back again and again. The viruses remain in the ganglia of the human body for a long time. Moreover, they reproduce. Especially in the recurrent herpes episodes, the deep corneal layers are affected. This often leads to dense scarring. The cornea may swell and opacification may occur, which severely impairs vision. Immune reactions to viral antigens in the cell surfaces of the deep corneal layers may also occur. Consequently, opacification and permanent limitation of vision may occur. If ocular herpes is not treated promptly and adequately, blindness cannot be ruled out.
When should you see a doctor?
In most cases, eye flu heals on its own within a few days or weeks, even without medical advice. However, if the symptoms persist over a longer period of time, a doctor should be consulted. If the complaints increase in the course of the disease and increasingly affect the vision, an eye flu should also go to the doctor’s office. Anyone who works in the food sector or has a lot to do with other people in their job must have the symptoms clarified quickly for hygienic reasons alone. The same applies if a high level of concentration is required at work and there is an acute risk of accidents due to the eye flu. Patients with a previous disease of the immune system should have an eye flu treated just as quickly as pregnant women, elderly people and other risk groups. Consequential diseases such as conjunctivitis or uveitis should be medically clarified immediately. Further complications can usually be avoided by rapid treatment. If secondary symptoms such as severe headache or swelling of the lower eyelids have already developed, hospitalization is recommended for further clarification.
Treatment and therapy
If a herpes infection is present in the eye, the ophthalmologist will prescribe antivirals to curb the explosive multiplication of the viruses and thus improve the course of the disease. These prescription medications are administered locally in the form of eye drops, eye ointment, and/or as tablets. Drug therapy can be supported by cooling the eye (especially if swelling is present), avoiding direct sunlight and protecting the eyes as much as possible. Under no circumstances should over-the-counter eye drops be used if herpes is suspected. Self-treatment of herpes infections of the eye is not possible and the immediate visit of an ophthalmologist for clarification of the diagnosis and therapy is strongly advised. The risk of infection with eye herpes is less high than with lip herpes. Nevertheless, special attention should be paid to hygiene in order to avoid infecting other people living in the household. No shared towels or washcloths should be used, and laundry should be washed with disinfectant detergent until the acute infection is completely healed.
Outlook and prognosis
Ocular herpes is an infectious disease with varying degrees of severity. The outlook and prognosis for a prompt and untroubled recovery depends on this. Affected individuals complain in many cases of severe redness and excessive itching. If this clinical picture remains entirely without medical or drug treatment, then these symptoms will increasingly intensify. Increased redness can lead to the formation of pus.The eye of the affected person may become increasingly sticky, and a foreign body sensation may develop. These accompanying symptoms will persist if treatment by a physician is not resorted to. If medical and drug treatment is resorted to, then the prospect of timely recovery looks more positive. The existing infection can be effectively fought by the right medication, so that the possible accompanying symptoms are more bearable and pleasant. A significant improvement can be expected within seven days if the patient resorts to appropriate treatment. Otherwise, ocular herpes may persist for several weeks and individual accompanying symptoms may increase significantly.
Prevention
Prevention of herpes infection of the eye can be achieved by careful observance of hygienic measures and a healthy lifestyle. Since 90% of the population carries herpes viruses, the most important prevention is to avoid acute outbreaks of herpes. This is best achieved by strengthening the immune system as much as possible, eating a healthy diet, getting enough sleep and avoiding excessive stress as much as possible. It is also particularly important to take strict care not to bring the infection from the affected area into the eyes with your fingers, for example by carelessly rubbing your eyes with your fingers, in the case of acute herpes on other parts of the body – usually the lips.
Aftercare
Existing eye herpes is an infectious disease that should ideally be treated by a doctor and medication. If the affected person decides to undergo such treatment, then a complete and prompt recovery can be expected. Any symptoms and complaints that occur will subside, so that no complications or side effects arise. If this bacterial infectious disease has completely subsided, then the affected person can completely dispense with further visits to the doctor. Even without regular visits to the doctor, this disease does not return. The situation is different if complications have arisen from the existing eye herpes. The human eye is a very sensitive organ, so a visit to the doctor should not be delayed. The same applies to follow-up examinations, if they are absolutely necessary. In the case of ocular herpes, permanent consequential damage can occur under certain circumstances if regular follow-up examinations do not take place. An existing inflammation of the eye must completely subside, otherwise a life-threatening abscess can form. Blood poisoning or other life-threatening complications are possible if affected persons completely forgo follow-up examinations. An ophthalmologist should be consulted at the latest at the first signs of an exacerbation. Follow-up examinations do not have to be carried out after eye herpes has been overcome. However, if complications have occurred in advance, then the entire course of the disease should be observed by a doctor.
What you can do yourself
Anyone suffering from an eye infection due to herpes viruses should immediately take appropriate medical therapy to prevent possible consequential damage. Parallel to the medical treatment, the affected person can get relief with numerous self-help tips and accelerate the process of recovery. It is advisable to apply cold compresses to the everyday treatment of eye herpes in order to alleviate the symptoms. Artificial tears can be used to reduce dryness in the eye along with its unpleasant symptoms. Furthermore, over-the-counter eye ointments and eye drops with heparin are helpful. Those suffering from ocular herpes should avoid direct exposure to the sun and take it easy on the body. Relaxation exercises or meditation can alleviate stress, which puts an unhealthy strain on the entire organism, and boost recovery. When suffering from eye herpes, it is extremely important to protect one’s immediate surroundings from possible infection. Therefore, all hygiene items, such as washcloths or towels, should not be used by other people. Likewise, the affected person should maintain good hand disinfection. Handshaking with other people should be minimized if possible during the eye disease. People who suffer from herpes at regular intervals are particularly susceptible.These people have too few antibodies in their immune system and therefore have an increased risk of an exacerbation.
