The herpes simplex virus is a common virus that affects many people. This virus can cause cold sores, but it can also cause sores to appear on the eyes. When it affects a person's eyes, the condition is known as ocular herpes or herpetic eye disease.

Eye herpes is a concern because it can have uncomfortable symptoms. In rare instances, eye herpes can affect the deeper layers of a person's eyes and their vision.

In this article, we examine the types of herpes that can affect someone's eye and the symptoms that may occur. We also look at the diagnosis and treatment options available for eye herpes.

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Eye herpes is also known as ocular herpes or herpetic eye disease.
Image credit: Powerfloh, 2013

Two major herpes simplex virus types exist. They are:

  • Type 1: Type 1 herpes virus commonly affects the face and is responsible for symptoms that include "fever blisters" or cold sores.
  • Type 2: Type 2 herpes virus is the sexually transmitted form of the virus. While this type mainly causes symptoms on the genitals, it can also affect the eyes.

According to the American Academy of Ophthalmology, type 1 herpes simplex virus is the most common cause of eye infections.

Most often, a person will be infected with the herpes simplex virus by skin to skin contact with someone who already has the virus.

It often lays dormant in the nerve cells and can travel along the nerves to the eye when activated.

Most people have been infected with the virus at some point in their lives, but not everyone gets symptoms from the virus.

When a person gets herpetic eye disease herpes, they can experience a variety of symptoms. These can be in both eyes, but often one eye is affected more than the other.

Some of the symptoms depend on what part of the eye is affected. Examples of these symptoms include:

  • feeling as if something is in the eye
  • headache
  • light sensitivity
  • redness
  • tearing

Sometimes a person may also experience herpes sores on top of the eyelids. These may resemble a rash that has blistering. The blisters will form crusts that usually heal within 3 to 7 days.

If the herpes virus affects the cornea, the inside of the eye, or the retina, a person may find their vision is reduced.

Typically, eye herpes does not cause a lot of pain, even though a person's eye may look painful.

The symptoms of a herpes simplex virus affecting the eye may be very similar to those of the herpes zoster virus, which causes chickenpox. However, a herpes zoster infection is more likely to result in a rash that has a distinct pattern that occurs in only one eye.

Another condition that can have symptoms similar to that of herpes zoster is pink eye, which is also known as conjunctivitis.

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Fever and stress may trigger a dormant virus to start reproducing.
Image credit: Burntfingers, 2015

A person may get the herpes virus after it has been released via nasal secretions or spit. This is especially true when a person has a cold sore.

The virus within the secretions can then travel through the body's nerves, which can include the eye nerves.

In some cases, the virus enters the body and does not cause any problems or symptoms. In this form, it is known as lying "dormant."

Certain triggers can sometimes cause a dormant virus to start reproducing and cause eye irritation. Examples of these triggers include:

The herpes virus can be highly contagious. However, just because a person has or comes in contact with the herpes virus does not mean that they will get eye herpes.

Doctors diagnose herpetic eye disease by taking a medical history and asking a person about their symptoms. They may inquire when a person first noticed their symptoms and what makes them worse or better.

A doctor will also conduct a physical examination of the eye. This will include using a special microscope known as a slit lamp to visualize the eye's surface and potentially the eyelid.

Doctors can usually diagnose eye herpes by looking at the sores. If the deeper layers of the eye are infected, they will have to use special instruments to measure the eye pressure. They will also need to inspect the deeper eye layers whenever possible.

As part of the diagnosis, a doctor may also take a small cell sample known as a culture from a blistered area. They will then send this sample to a lab for testing for the presence of the herpes simplex virus.

For the most part, eye herpes affects the clear topmost portion of the eye. This condition is known as epithelial keratitis.

Sometimes eye herpes can affect the deeper layers of the cornea when it is known as stromal keratitis. This condition is more concerning to eye doctors because it can cause scarring on the cornea, which can permanently affect 's vision.

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A doctor may prescribe an antiviral eye drop.

No cure currently exists for herpetic eye disease. Instead, a doctor can prescribe medications that reduce the effects and symptoms of the condition. Treatments most often depend upon where the eye herpes is located.

Eyelids

Doctors will prescribe topical ointments, such as an antiviral or antibiotic ointment for a person to gently place on their eyes.

While antibiotic ointments will not address the herpes infection, they will keep other bacteria from entering the open, blistering areas of the eyelid.

Outer eye layers

If the eye herpes only affects the outermost layers of the eye, a doctor may prescribe an antiviral eye drop or an oral antiviral medication, such as Acyclovir. These help to reduce the effects of the virus and could shorten the time a person has the virus.

Deeper eye layers

If the herpes virus has affected deeper layers of the eye, a doctor may prescribe antiviral eye drops and oral medications.

A doctor may also prescribe steroid eye drops. These help to reduce eye inflammation that can otherwise cause increased eye pressure.

Prevention

As eye herpes is prone to cause further infections, some doctors may recommend taking antiviral medicines on a regular basis to reduce the risk of someone getting eye herpes again.

Recurrent herpetic eye infections can lead to greater eye damage, which is why doctors want to prevent their recurrence.

Doctors may recommend that a person take an antiviral medication a few days before they have surgery so that they can prevent the stress of the surgery from triggering a herpes outbreak.

According to the American Academy of Ophthalmology, doctors diagnose about 50,000 new cases of eye herpes each year in the United States. While they cannot cure eye herpes, they can prescribe treatments that reduce the length of symptoms.

If a person has recurrent eye infections or starts to experience vision loss, they should seek an eye specialist for assessment and instructions on additional treatments.