How Is Herpetic Eye Disease Diagnosed
The two different types of herpetic eye disease have different symptoms. One thing they have in common, however, is that they can both be very painful because they affect the nerves directly.
The problem may be caused by herpes zoster ophthalmicus if your doctor finds some or all of these symptoms:
- Pain in and around only one eye
- Redness, rash or sores on the eyelids and around the eyes, especially on the forehead . Its appearance is similar to poison ivy blisters that turn into scabs over 1 to 2 weeks. The rash is subtle in younger people and more severe in older.
- Redness of the eye
- Swelling and cloudiness of the cornea
- Flu-like symptoms
- Tingling/numbness in forehead before the rash appears
The problem may be caused by herpes simplex keratitis if your doctor sees these symptoms:
- Pain in and around only one eye
- Redness of the eye
- Pain when looking at bright light
- Swelling or cloudiness of the cornea
Many other conditions can display these symptoms, so it is necessary for a doctor to perform a full examination of the eye to learn the cause. Your doctor might want to use special tests if it looks like herpetic eye disease might be present. He or she will probably check the pressure inside the eye, for example. There is also a special dye called fluorescein that the doctor might put into the eye. This dye glows under ultraviolet light and can help to show the doctor if the virus is causing problems on the surface of the eye.
Challenges And Recent Progress In Controlling Ocular Herpes
Ocular herpes is currently an infection for life. For a very long time, finding a cure for HSV has been a significant unmet need for physicians and scientists alike. Currently, with the exception of VZV, there is no vaccine for herpesvirus infections . Also, the currently approved therapies to control ocular herpes provide limited efficacy and often have to be combined with steroids to reduce symptoms especially during the recurrent cases of HSK. In general, current treatment modalities reduce the symptoms only by a few days . Likewise, long-term use of steroids has its own serious side effects, which includes increase in intraocular pressure and possible onset of secondary glaucoma . While the clinically approved drugs, mainly nucleoside analogs, are clearly beneficial , they also suffer from their share of pitfalls. Development of resistance against the most commonly used drug, acyclovir, is common and long-term use of it is known to cause renal toxicity . Thus, there is a great need to develop new antiviral therapies for herpesvirus infections. Both currently approved as well as some emerging therapies are discussed below.
Eye Herpes Disease: Symptoms Treatment & More
Pain in and around one eye accompanied by redness and blurred vision could be a symptom of pink eye or a stye.
However, in some circumstances, it is a sign of eye herpes and should be looked at by your healthcare provider to avoid more serious health complications.
Eye herpes, also known as herpes keratitis or ocular herpes, affects over half a million Americans and is regarded as one of the leading causes of blindness.
Caused by the herpes simplex virus , infected persons may experience an initial flare-up, and others may battle with the recurrence of the condition for the rest of their lives.
In this article, I will discuss eye herpes in detail including the causes, types of eye herpes, symptoms, how it is diagnosed, and treatment options available.
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An Inside Look At The Eye
The herpes simplex virus Herpes Simplex Virus Infections Herpes simplex virus infection causes recurring episodes of small, painful, fluid-filled blisters on the skin, mouth, lips , eyes, or genitals. This very contagious viral infection… read more never leaves the body after an initial infection. Instead, the virus remains in a dormant stage in the nerves. Sometimes, the virus reactivates and causes a recurrence and further symptoms.
Primary herpes simplex eye infections usually occur in children and cause a mild keratoconjunctivitis, which is inflammation of the cornea and of the conjunctiva .
The primary infection resolves without treatment and the inactivated virus hides in the nerve roots. Several types of stress can reactivate the virus:
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Exposure to intense light
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Significant physical stress
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Immunosuppression
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Use of corticosteroids
If the infection reactivates, it can affect the cornea more seriously and may result in temporary or permanent visual loss.
Herpes simplex keratitis is a major cause of blindness worldwide.
Eye Involvement And Symptoms
When the eye is afflicted by herpes simplex, it usually affects only one eye and most often occurs on the cornea . This type of corneal infection is called Herpes Keratitis. The infection may be superficial, involving the top layer of the cornea, and usually heals without scarring, or it may involve the deeper layers of the cornea. If the infection involves the deeper layers, it may lead to scars of the cornea, loss of vision, and sometimes even blindness. Less commonly, herpes simplex virus may also infect the inside of the eye or the retina .
Symptoms of herpetic eye disease may include blurred vision, sensitivity to light, and pain and redness of the eye.
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How Does Herpetic Eye Disease Develop
Like many viruses, the herpes simplex 1 and varicella zoster viruses are actually present in most adults. The viruses in the herpes family usually live around the nerve fibers in humans without ever causing a problem. Occasionally, the viruses will start to multiply, or they will move from one area of the body to another, and that is when herpetic disease breaks out. This often happens when the immune system of the body is weakened by some other health problem.
Reduce Your Risk Of Exposure To Eye Herpes
There are no clear ways to prevent the spread of herpes keratitis, but there are some steps you can take to keep your eyes safe.
- If you have cold sores, avoid touching your eyes. Wash your hands after you touch your lips during an outbreak to prevent spreading the virus to other areas.
- Do not share eye drops or eye makeup with others. The herpes virus can be transferred this way.
- Keep your contact lenses clean, as recommended by your optometrist. If you experience a herpes outbreak, throw out that pair of contacts.
If you are cautious, you can avoid transferring the virus to other areas of your body. It does take vigilance during outbreaks.
In the first year after contracting eye herpes, 20 percent of people will experience a recurrence of symptoms. If outbreaks become frequent, they can be managed with regular, often daily, medication. Otherwise, your doctor will prescribe medication that you will take only as needed, during your less frequent outbreaks.
For some people, the outbreaks are more frequent and more severe initially. Then, they stabilize over time and become less frequent.
While you may never need medication to treat eye herpes, it is important to get an appropriate diagnosis if you experience the symptoms listed above. Having more than one outbreak puts you at risk for scarring inside your cornea and other parts of your eye, which can lead to serious vision loss over time.
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Ocular Herpes Causes Is It Contagious
While the exact cause of a herpes virus outbreak is unknown, there seem to be stress-related factors associated with virus reactivation. These triggers include fever, sunburn, major surgical or dental procedures, and trauma. Herpetic eye disease is not sexually transmitted, and the virus is different from the one that causes genital herpes.
The herpes simplex virus enters the body through the nose or mouth and travels to the nerves, where it settles and can remain dormant for years. Its possible that it may never wake up. However, once an initial outbreak occurs, untreated eye herpes has about a forty to fifty percent chance of returning.
The herpes zoster virus is transmitted through contact with someone whos having an outbreak or through self-contact by touching a cold sore and spreading the virus to another part of your body. The virus is in its contagious stage when there are visible blisters present.
Where To Get Medical Help
Get medical help as soon as possible if you have these symptoms. They could be caused by a herpes simplex infection or another eye condition that needs to be treated quickly.
If it’s not treated, there’s a chance your vision could be affected.
You can get help and advice from:
- a GP or NHS 111 they can advise you about services in your area and refer you to an eye specialist
If you wear contact lenses, take them out and do not use them again until you’re advised by a medical professional that it is safe to do so.
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Recurrence Of The Condition
Once you contract herpes, the virus stays in your body for life.
According to the NHS, one in five people with eye herpes will experience a recurrence of the condition within a year.
Symptoms during the initial infection will usually be the most severe.
After that, the virus will transfer from your skin cells into your nervous system where it can lay dormant until it is triggered by certain circumstances.
Most people will only experience one flare-up of the virus.
For those who experience more flare-ups, its important to know that the virus can reactivate in the following situations:
- Illness or surgery
- A reaction to foods or medicines
Repeated flare-ups of herpes eye disease can cause permanent scarring of your cornea over time and lead to vision loss and in some cases, blindness.
This is why it is important to visit your healthcare provider and get the necessary treatment to manage your symptoms.
How Is Herpes Zoster Ophthalmicus Treated
Because herpes is a virus, antibiotics such as penicillin are not an effective treatment. The only drugs that will work against herpes infections are antiviral medications.
Depending on how serious the herpes zoster ophthalmicus is and what part of the eye is affected, your doctor will recommend antiviral eye pills, drops or both. No matter what kind of medicine is recommended, it is important to keep using the medicine for as long as your doctor recommends. Even though the eye might start to look or feel better, the infection could come back if you stop taking your medicine too soon.
If the infection is affecting the cornea, another kind of eye drops called corticosteroids might also be recommended. Corticosteroids can help control the inflammation caused by the disease, but in some patients they can also raise the pressure in the eyes. If corticosteroids are being used, it is important for the patient to come back to the doctor’s office so the pressure can be checked. In some cases, a drop that dilates the pupil may be prescribed to prevent damage to the iris caused by inflammation.
Unfortunately, herpetic eye disease can be painful even after several days of treatment when the eye is starting to look better. This can be discouraging, but it does not mean that the treatment is a failure. The medicines are working, and the pain will go away eventually.
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Different Forms Of Eye Herpes
There are various types of herpes ranging from the ones that cause simple infection to a condition that can possibly cause blindness:
- Herpes Keratitis: It is considered the most common form of eye herpes. It is a form of corneal infection that is viral in nature. This form of ocular herpes generally affects only the top layer, or the epithelium, of the cornea, and mostly heals without scarring.
- Stromal Keratitis: It is a condition in which the infection penetrates into the deeper layers of the cornea. This can cause scarring, vision loss, and sometimes, blindness. Stromal keratitis is evidently caused by a late immune response to the original infection. According to NEI, around 25% of new and recurring cases of eye herpes result in stromal keratitis.
- Iridocyclitis: It can be understood as a serious form of eye herpes in which the iris, as well as the surrounding tissues in the eye, become inflamed, leading to severe sensitivity to light, blurry vision, pain, and redness in the eyes. It is a kind of uveitis that affects the frontal part of the inside of the eye. If the infection is limited to the retina or the inside lining of the back of the eye, then it is called herpes retinitis.
What Other Information Should I Know
Keep all appointments with your doctor.
It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
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Treatments For Herpes Simplex Eye Infections
Most herpes simplex eye infections get better in 1 to 2 weeks, although they can last longer. Treatment is usually needed to reduce the risk of complications.
The main treatments are:
- antiviral eyedrops or ointment these stop the virus spreading and are usually used several times a day for up to 2 weeks
- steroid eyedrops these may be used in combination with antiviral drops to reduce inflammation
- antiviral tablets these are occasionally needed to treat more severe infections and afterwards to stop them coming back
Make sure you follow the advice you’re given and take any prescribed treatment as directed. It’s important to complete the recommended course of any medicine even if your symptoms go away. This will help stop the virus coming back.
Types Of Ocular Herpes
Herpes Simplex Keratitis
Primary HSV. Once a person is infected, this virus may manifest as herpes simplex 1 or become dormant. If dormant, it remains dormant until some stress triggers an outbreak. This initial outbreak is rarely noticed and rarely affects the cornea. Sometimes a patient will have an episode of conjunctivitis or blepharitis that resolves itself.
Recurrent HSV. If HSV recurs, it most often affects the cornea, resulting in herpes simplex keratitis. Although it usually affects the cornea, it can cause retinitis, trabeculitis , anterior uveitis, and optic neuritis.
Epithelial keratitis. This is the most common and mildest form. It affects only the top epithelial layer of the cornea. Inflammation of the epithelial layer of the cornea takes the form of several types of sores or ulcers. They are identified according to their shape and location.
Stromal keratitis. Inflammation of a deeper layer of the cornea, the stroma, is more often associated with immune system issues it can be quite serious, resulting in permanently blurred vision and blindness. It can manifest as a wide range of interrelated conditions. Some of these include interstitial keratitis , necrotizing keratitis, disciform keratitis , and keratouveitis . Stromal keratitis develops in about 25% of those people who have epithelial keratitis.
Recurrence. Recurrence of epithelial or stromal keratitis is 10% after 1 year, 23% after 2 years, and 50% after 10 years.
Herpes Zoster Ophthalmicus
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How Is Herpes Simplex Eye Infection Diagnosed
Your family doctor will usually examine your eye with a magnifier. They may also put some stain on the front of your eye. This is used to show up any irregular areas on the transparent front part of the eye. With a herpes simplex infection they will often see a small scratch on the cornea. The typical ulcer which develops is called a dendritic ulcer. Dendritic means branching. The ulcer is not round with a smooth edge but like a tree with many finger-like branches, as below:
Eye Herpes Vs Pink Eye
An ocular herpes simplex virus infection shares common signs and symptoms with another common eye infection called conjunctivitis , caused by bacteria, a virus, or allergies.As many as 25% of eye herpes cases go misdiagnosed as pink eye.6
While the two conditions are similar, there are slight differences that include:
- Conjunctivitis usually occurs in both eyes
- HSV eye infections typically only occur in one eye
- Eye culture that is positive for an HSV infection
- An adenovirus causes pink eye
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Signs Of Herpes Simplex Keratitis
HSK has a highly variable and unpredictable courseCan be considered as a spectrum of four distinct disease entities :
Epithelial Initially punctate lesions, coalescing into dendriform pattern
- dendritic ulcer, single or multiple
- opaque cells arranged in a stellate pattern progressing to a linear branching ulcer terminal bulbs may be visible
- associated with reduced corneal sensitivity
- continued enlargement may result in an amoebic or geographic ulcer
StromalStromal infiltrates, vascularisation, necrosis, scarring, uveitis and keratic precipitates, possibly raised intraocular pressure
Disciform keratitisCentral or eccentric zone of epithelial oedema overlying an area of stromal thickeningFolds in Descemets membrane, uveitis and keratic precipitates
Metaherpetic ulcer Due to a combination of denervation, drug toxicity, persistent defects in epithelial basement membrane
Herpes Simplex Type I
Herpes simplex Type I is the same virus that causes cold sores on the lips and mouth. In the eye, it usually infects the cornea. This is known as herpes simplex keratitis. It typically affects the outermost corneal layer, called the epithelium, and heals without scarring.
In about 25 percent of cases, the virus infects the deeper corneal layer known as the stroma . This is more serious because it can lead to scarring and vision loss. The virus can also infect the iris and surrounding tissues as well as the retina which is the inside lining of the back of the eye .
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