Herpes infection of the eye: Herpes on the eye symptoms and treatment

A herpes infection of the eye is caused by certain herpes viruses. Not every herpes infection is the same – herpes viruses can cause various diseases of the eye and accordingly different symptoms can appear. In this article, you can find out more about herpes infections of the eye, the characteristic signs and treatment options.

Types of herpes viruses / ocular herpes

There are several types of herpes viruses, which generally affect different parts of the body. Not every herpes infection leads to symptoms in the eyes. The herpes viruses include, for example

• Herpes simplex virus type 1: Leads to infections in the facial area, including the eyes.
• Herpes simplex virus type 2: Causes infections of the genitals.
• Varicella zoster virus: Known as chickenpox or, if the virus is reactivated, as shingles.

Transmission of herpes infection of the eye

Infection with the herpes simplex virus type 1 usually occurs through droplet infection. The eye itself can be infected through a smear infection. Another possibility is that the herpes infection is in other areas of your own body (e.g. lip) and the herpes viruses spread through the body.

Various eye diseases caused by herpes viruses

A herpes infection of the eye does not usually affect the eye as a whole. The virus breaks out in certain parts of the eye, which can lead to different or combinations of eye diseases:

• Herpes simplex blepharitis
• Herpes simplex conjunctivitis
• Herpes keratitis
• Herpes-associated uveitis
• Herpes simplex retinitis
• Zoster ophthalmicus

Herpes simplex blepharitis

With herpes simplex of the eyelids (so-called herpes simplex blepharitis), several blisters form on the eyelids, which are filled with a fluid. There may also be swelling of the eyelid. This form of ocular herpes is often observed as part of initial infections and in children. The infection is treated with a virus-inhibiting ointment.

Herpes simplex conjunctivitis

Conjunctivitis caused by herpes viruses is known as herpes simplex conjunctivitis. The symptoms of herpes simplex conjunctivitis are largely similar to conjunctivitis caused by bacteria: Burning sensation, itching of the eyes, foreign body sensation, sticky eyelids. In addition, the typical blisters can develop on the eyelids. Here too, an antiviral ointment is used for treatment.

Herpes simplex conjunctivitis is often accompanied by herpes simplex of the eyelids. The combination of both diseases is also referred to as blepharoconjunctivitis. If corneal inflammation is present in addition to herpes simplex conjunctivitis, this is referred to as herpes simplex keroconjunctivitis.

Herpes keratitis

Herpes keratitis is an inflammation of the cornea caused by herpes viruses. Herpes keratitis is the most common form of herpes infection in the eye. It can be caused by herpes simplex viruses or varicella zoster viruses. People affected by herpes keratitis experience the following symptoms:

• Eye pain
• Increased sensitivity to glare
• Swollen eyelids
• Watery eyes
• Deterioration of vision

If the herpes keratitis was triggered by varicella zoster viruses, blisters may also appear on the tip of the nose (so-called Hutchinson’s sign). If you have symptoms of herpes keratitis, you should consult an eye specialist – keratitis can lead to secondary problems: Corneal scarring, corneal curvature, cataract or glaucoma. Treatment can be with medication or ointments.

Herpes-associated uveitis

Herpes-associated uveitis describes an inflammation of the middle skin of the eye (uvea) caused by herpes viruses. Those affected often report increased sensitivity to glare and eye pain. Uveitis is treated with virus-inhibiting medication. In contrast to treatment for herpes keratitis, cortisone can also be used here. Herpes-associated uveitis can lead to secondary diseases of the eye:

• Keratitis: Herpes-associated uveitis and herpes keratitis often occur simultaneously.
• Herpetic trabeculitis: Herpes viruses can lead to inflammation of the trabecular meshwork of the eye (near the outer edge of the iris).
• Glaucoma (cataract): The aqueous humor of the eye flows out via the trabecular meshwork. If this is inflamed, the outflow is inhibited and there is an increased risk of glaucoma.

Herpes simplex retinitis

In rare cases, the herpes viruses can cause inflammation of the retina. A feared danger is that this can lead to retinal necrosis – the cells of the retina die irreversibly, which can ultimately lead to blindness.

Zoster ophthalmicus

Infection with the varicella zoster virus can affect the eyeball nerve (known as the ophthalmic nerve) – this is known as zoster ophthalmicus. Zoster ophthalmicus results in various diseases. The most common is corneal inflammation. However, other diseases can also occur:

• Anterior uveitis (inflammation of the iris)
• Neuritis nervi optici (optic nerve inflammation)
• Retinal necrosis (death of the retina

Can a herpes infection be cured?

If you are infected with herpes viruses, the viruses remain in your body for the rest of your life – there is no complete cure. However, the viruses do not cause permanent symptoms. In some people, symptoms only occur once after the initial infection, while in others the viruses can be reactivated or an outbreak encouraged by various factors:

• UV radiation
• Increased body temperature
• Physical exertion
• Psychological strain (stress)

When first infected with a herpes simplex virus, those affected usually only experience mild symptoms, such as an elevated temperature, a feeling of exhaustion or cold-like symptoms. Afterwards, the herpes viruses “lie dormant” in so-called ganglia (accumulations of nerve cells). Reactivation of the viruses ensures that they reach the surface of the skin again via nerve fibers. This can result in the usual herpes symptoms. In most cases, blisters form on the skin.

Treatment of ocular herpes

As already mentioned, antiviral medication or ointments are often used. In addition, the administration of medication via an infusion or eye drops can also be considered. Common medications used in the treatment of herpes infections in the eye are

• Antivirals (virus-inhibiting active ingredients): Acyclovir, valaciclovir, ganciclovir, trifluorothymidine
• Glucocorticoids (drugs containing cortisone)

Surgery by an ophthalmologist is usually only performed if the consequences of a herpes infection are to be treated. If corneal scars occur, a corneal transplant is an option. Surgical intervention (vitrectomy) can also be performed in the case of retinal necrosis.

Diagnosis and examinations of herpes examinations

Various methods can be used to diagnose ocular herpes, e.g:

• Slit lamp examination: Opacities and edema become visible.
• Fluorescin staining: corneal injuries can be detected.
• Examination of corneal sensitivity (e.g. using an aesthesiometer)
• Eye tests: To assess visual acuity.
• Funduscopy (examination of the back of the eye): Inflammation and retinal necrosis become visible.

As there are other pathogens that can cause similar symptoms – e.g. adenoviruses or chlamydia – the most reliable method of diagnosing a herpes infection is a PCR test. This allows the exact pathogen and the type of herpes virus to be determined. To do this, the attending physician takes a swab from the eye or aqueous humor.

Preventing herpes infections on the eye: tips against herpes on the eye

Herpes infections can cause major damage to the eye. Many people carry herpes viruses, which are highly contagious. This makes it all the more important to take measures to protect yourself or others from infection:

• Frequent and thorough hand washing
• Change towels often and wash them hot
• Use virucidal disinfectants
• Do something about the weakened immune system
• Actively support the healing process