Eye herpes is a highly contagious eye infection caused by the herpes simplex virus. Left untreated, it can lead to permanent vision impairment. Where does the herpes infection in the eye come from and how is it treated?
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Brief overview: eye herpes
Cause: An infection with the contagious herpes simplex virus triggers eye herpes. The pathogens are usually transmitted by a smear infection.
Treatment: The disease is treated locally with antivirals as an eye ointment or drops, tablets for systemic therapy are also possible.
Diagnosis: In the ophthalmological practice, an examination is carried out with a slit lamp, and the sensitivity of the cornea is also checked.
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What is eye herpes?
Eye herpes is caused by the same virus as cold sores. While the blisters on the lips are uncomfortable but mostly harmless, eye herpes can leave permanent damage to the eye and even lead to blindness if left untreated.
The infection usually only occurs on one side and can affect different areas of the eye. In most cases, the cornea is affected (herpes keratitis or herpes corneae). Depending on how deep the pathogens penetrate into the eye, two forms are distinguished:
In addition to the cornea, the eyelid, conjunctiva, iris or choroid can also be affected by eye herpes. The disease is to be distinguished from an infection with the varicella-zoster virus, which causes shingles (herpes zoster). This can also occur in the eye and is known as zoster ophthalmicus.
frequency of infection
In the western world, herpes keratitis is considered the most common cause of severe impairment of vision: in Germany, around 12 out of 100,000 people contract it every year. 1.5 million new cases occur worldwide each year.
Typical symptoms of eye herpes
The symptoms of a first (primary) infection with the herpes simplex virus in the eye are often similar to those of conjunctivitis:
- itchy, watery, red eyes,
- foreign body sensation
- and increased sensitivity to light.
Therefore, eye herpes is usually not recognized in this phase. The symptoms of reactivation are highly dependent on which area of the eye is affected. It is often these:
- eye pain
- itching
- redness
- tear flow
- sensitivity to light
- foreign body sensation
- fluid-filled blisters
- visual impairment
In most cases, only one of the two eyes is affected. However, the liquid in the typical cold sore is highly contagious and can lead to transmission to the other eye or to other people.
Eye herpes: causes and risk factors
Eye herpes is caused by infection with the herpes simplex virus. This virus is highly contagious and is transmitted through smear infection, i.e. contact with infected people or surfaces. The initial infection usually occurs in childhood and is only accompanied by harmless symptoms.
More than 90 percent of adults are infected with the herpes virus: After the primary infection, the virus settles in the ganglia of the nervous system, where it can remain “dormant” for years without showing any symptoms.
Various factors can reactivate the virus and cause herpes to break out again:
- stress
- intense sunlight
- Fever
- Taking immunosuppressants or corticosteroids (cortisone)
- weakened immune system
- diabetes mellitus
- Menstruation
- contact lenses
- Injuries or surgeries to the eye
HIV and AIDS
Treatment: How is eye herpes treated?
Herpes on the eye is treated with so-called antivirals – drugs that inhibit the multiplication of the herpes virus. Depending on which layer of the eye is affected, doctors prescribe eye drops, ointments, tablets or infusions
- acyclovir,
- ganciclovir
- or trifluridine.
Treatment with antiviral drugs lasts at least a week, but can also take several weeks. Those who regularly relapse and suffer from ocular herpes more than twice a year receive long-term treatment with aciclovir tablets in some cases.
If bacterial inflammation has also occurred as a result of the immune system weakened by eye herpes, antibiotic eye drops are prescribed. In the case of stromal keratitis, which extends into the deeper layers of the cornea, cortisone drops are also used.
Transplantation of the cornea in severe cases
If larger scars have formed due to an eye herpes infection that impair vision, a corneal transplant (keratoplasty) may be necessary in rare cases. A prerequisite for such an operation is a herpes infection that has been inactive for several months.
Home remedies for eye herpes?
Herpes on the eye cannot be treated with home remedies. However, ophthalmological therapy can be supported with the following measures:
eye-friendly behavior (reduction of screen times)
consistent hand hygiene
Wash towels and washcloths in hot water and do not share them with others
Avoid direct sunlight and wear sunglasses
disinfected, cold spoons against pain and itching
Diagnosis: This is how eye herpes is determined
The ophthalmologist is responsible for the diagnosis and treatment of eye herpes. In a detailed conversation (anamnesis), the symptoms and the previous medical history are asked. The affected eye is then examined using a slit lamp. It enables the eye to be viewed at high magnification. Under certain circumstances, a special dye (fluorescein) is dropped into the eye beforehand, which makes damaged areas of the cornea visible.
Since the cornea is often significantly less sensitive when infected, a test of corneal sensitivity is also carried out: To do this, it is briefly touched with a cotton swab or a so-called aesthesiometer to check the reaction. A corneal or conjunctival swab is used to detect the virus, and an eye test checks whether the infection has already affected vision.
Course and prognosis in ocular herpes
If only the top layer of the cornea is infected (epithelial keratitis), eye herpes usually heals within a few weeks without consequences. Stromal keratitis usually takes much longer to heal and is associated with a higher risk of complications (such as scarring on the cornea, neovascularization or glaucoma).
The probability of the disease recurring is high: a third of those affected suffer a relapse within two years. With each recurrence, the risk of corneal opacity increases, and regular medical check-ups are recommended.
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