Symptoms Of Herpes In The Eye

Treatment For Eye Herpes Suppresses The Virus

Getting an accurate diagnosis and appropriate treatment plan is important because severe forms of eye herpes can move into the stroma, a deeper layer of the cornea, and lead to stromal keratitis, which is harder to treat and can cause blindness. You may also develop iridocyclitis, when herpes infects the iris.

An optometrist or ophthalmologist will look at your eyes while your symptoms are active to make a diagnosis. Typically, lab testing is not necessary, but it can be performed in cases when the virus is less active, or symptoms are less clear.

If a lab test is needed, this will be a fluorescein eye stain. Your doctor will use an orange dye that fluoresces under certain light, and apply this stain to the surface of your eye, where the epithelial layer of your cornea is. This helps your doctor see any layers of scarring that may be from past herpes outbreaks.

Treatment for eye herpes is simple. Your doctor will prescribe eye drops or oral antiviral medications, which may be taken during outbreaks to suppress the virus and promote faster healing, or consistently for several years, depending on how severe and frequent outbreaks are when you are diagnosed. It is rare that eye herpes requires further treatment like surgery, but if outbreaks lead to scarring on your cornea or inside your eye, your eye doctor may recommend a laser procedure to remove scar tissue.

What Is Herpes On The Eye

Eye herpes is an umbrella term for infectious diseases of the eye caused by herpes simplex viruses . The viruses usually affect one side of the eyelid, iris, ciliary body, conjunctiva, cornea or retina. There they inflame and damage the tissue.

Doctors distinguish different forms of eye herpes, depending on which part of the eye the virus has affected:

Recovering From Eye Herpes

If youre treating your eye herpes with eye drops, you may need to put them in as often as every 2 hours, depending on the medication your doctor prescribes. Youll need to keep applying the drops for up to 2 weeks.

With oral acyclovir, youll take the pills five times per day.

You should see improvement in 2 to 5 days. The symptoms should be gone within 2 to 3 weeks.

After a first bout of eye herpes, about 20 percent of people will have an additional outbreak in the following year. After multiple recurrences, your doctor may recommend taking antiviral medication daily.

This is because multiple outbreaks damage your cornea. Complications include:

• numbing of the corneal surface
• perforation of the cornea

If the cornea is damaged enough to cause significant vision loss, you may need a corneal transplant .

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Treatment Of Herpes Simplex Keratitis

• Antiviral eye drops

• Antiviral drugs taken by mouth or vein

• Corticosteroid eye drops and drops that dilate the pupil

• Sometimes removal of infected and damaged eye cells

Treatment of herpes simplex keratitis should be started as soon as possible.

The doctor may prescribe an antiviral drug, such as trifluridine eye drop or ganciclovir eye gel.

Acyclovir, another antiviral drug, can be taken by mouth or by vein . The antiviral drug valacyclovir can also be taken by mouth. Sometimes, acyclovir or valacyclovir is prescribed to prevent frequent occurrences as well as in people whose episodes have been severe enough to threaten their vision.

Deep infections that cause a lot of inflammation may require use of corticosteroid drops.

Drops that dilate the pupil, such as cyclopentolate, atropine or scopolamine, can help relieve symptoms.

Occasionally, to help speed healing, an ophthalmologist gently swabs the cornea with a soft cotton-tipped applicator to remove infected and damaged cells.

Prevent Future Outbreaks With Medication

After one herpetic keratitis, the next one may soon be on the way. Frequently recurring eye herpes outbreaks put a strain on the eye and endanger vision. Sometimes surgeries or injuries make the eye particularly sensitive.

Then maybe a long-term prevention with antivirals makes sense to avoid new outbreaks of eye herpes. Patients usually take aciclovir tablets for a year or longer. You can also try to avoid risk factors for herpes reactivation.

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What Is Herpetic Eye Disease

Herpes simplex and herpes zoster are two viruses that can occasionally affect the eyes. When this happens, the condition is known as herpetic eye disease.

Most people are exposed to these viruses during their childhood and carry the dormant viruses in their bodies their entire lives.

These two viruses are not the same virus that causes genital herpes and herpetic eye disease is not regarded as a sexually transmitted disease.

• Varicella zoster virus: When this virus affects the eye, it is called herpes zoster ophthalmicus.
• Herpes simplex type 1: In the eye, it usually causes an infection of the cornea. This infection is called herpes simplex keratitis.

Although both of these problems are caused by a herpes virus, different medications are sometimes needed to treat the appearances of the disease.

Clinical Presentation And Diagnosis

Symptoms of HSV keratitis include pain in and around the eye, redness, sensation of a foreign body in the eye, blurred vision, light sensitivity, and watery discharge.8 Characteristic signs include a dendritic corneal lesion or disk-shaped, localized corneal edema and haze plus anterior uveitis .7 Diagnosis of HSV keratitis is confirmed by finding a dendritic ulcer via slit-lamp examination using fluorescein dye if not conclusive, viral culture of the lesion can confirm the diagnosis.7,9,10

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Hsv Keratitis: An Important Infectious Cause Of Blindness

Independent Senior Care Consultant Pharmacist and President of MZ Associates, Inc.Norwich, New YorkChair 2014-2015, Board of Commissioners, Commission for Certification in Geriatric PharmacyRecipient of the Excellence in Geriatric Pharmacy Practice Award from the Commission for Certification in Geriatric Pharmacy.

US Pharm.

An estimated 500,000 people in the United States have herpes simplex virus ocular disease.1 Each year about 50,000 new and recurring cases are diagnosed, with their treatment costing the nation approximately $17.7 million annually.1-4 Ocular HSV is considered the most common cause of infectious corneal blindness in the U.S.2

Many patients are often unsure as to whether or not to seek medical attention for an eye condition they experience as uncomfortable and distressing, but often consider unworthy of their doctors time and the expense of a consultation. Furthermore, ocular HSV is frequently misdiagnosed.5 In light of these issues, this article will address HSV keratitis and highlight the need to treat the condition and prevent recurrences, as well as the need for pharmacists to guide patients regarding these concerns. TABLE 1 provides details on signs and symptoms as well as treatment of the conditions discussed below.

Can Herpes Eye Disease Be Prevented

There is not much you can do to prevent infection with HSV1. Your healthcare provider may put you on a medicine to decrease your chance of having the virus reactivate. Avoiding excess sunshine and stress may also reduce your chances of reactivation.

You can help reduce your chance of complications if you see your eye care professional at the first sign of symptoms.

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Symptoms Of A Herpes Eye Infection

Herpes eye infections, also called herpes keratitis, are similar to other types of eye infections. However, they are often more painful, and, because they risk scarring of the cornea, we recommend seeking treatment ASAP rather than waiting for an infection to clear on its own.

Symptoms of an eye infection caused by herpes include:

• Eye pain or discomfort
• Sores or lesions on lips or gums

Most herpes infections are superficial, affecting only the eyelid or the exterior lining of the eye. However, corneal infections may become more serious, resulting in scarring that permanently affects vision.

Key Points About Herpes Eye Disease

Herpes eye disease is a group of eye disorders that result from infection with the herpes simplex virus .

• Infection with HSV is very common, but most people infected with HSV dont get herpes eye disease.
• Herpes eye disease can affect many different parts of your eye.
• You might only have one episode of symptoms from herpes eye disease, or your symptoms might come back occasionally as the virus reactivates.
• You might need to take antiviral and steroid medicines to treat an outbreak of herpes eye disease.
• Herpes eye disease can sometimes cause serious complications. This includes permanent scarring of your cornea and vision loss.

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Herpes On The Eye: Acute Retinal Necrosis

Rarely, the herpes simplex virus inflames the retina and its vessels. In the worst case, acute retinal necrosis occurs, in which cells of the retina die off. Here the disease often spreads to the second eye.

Most people with a weak immune system develop this form of eye herpes. But patients with a strong immune system can also be affected. The retinal involvement can occur separately or in the course of an HSV infection in the anterior segment of the eye.

Eye herpes can cause blindness due to acute retinal necrosis.

Diagnosis Of Herpes Simplex Keratitis

• An eye examination

• Sometimes a culture or other laboratory test

To diagnose a herpes simplex infection, a doctor examines the eye with a slit lamp What Is a Slit Lamp? . During the examination, the doctor may put drops in the eyes that contain a yellow-green dye called fluorescein. The fluorescein dye temporarily stains the damage in the cornea a bright green, making it possible for the doctor to see a damaged area that is not otherwise visible.

Sometimes, the doctor may swab the infected area to identify the virus, using either a viral culture or a nucleic acid amplification test . In a viral culture, microorganisms in a sample of blood, body fluid, or other material taken from the infected area are grown in the laboratory for identification. NAATs are used to look for an organism’s unique genetic material, its DNA or RNA . NAATs use a process that increases the amount of the bacteria’s DNA or RNA so that it can be more easily identified.

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Antiviral Drug Sharply Reduces Return Of Herpes Of The Eye

Researchers have found that an antiviral drug, often used to suppress genital herpes, also decreases the recurrence of herpes of the eye. A paper detailing these findings is published in the July 30, 1998 issue of The New England Journal of Medicine.

Scientists found that the drug acyclovir, taken by mouth, reduced by 41 percent the probability that any form of herpes of the eye would return in patients who had the infection in the previous year. Importantly, researchers noted a 50 percent reduction in the rate of return of the more severe form of the disease stromal keratitis among patients who had this infection during the past year. Stromal keratitis causes scarring of the cornea, which can lead to loss of vision and possibly blindness. Recurring episodes of stromal keratitis can often result in the need for a corneal transplant.

This drug is the first treatment that helps prevent herpes of the eye from returning, said Dr. Carl Kupfer, director of the National Eye Institute , part of the Federal governments National Institutes of Health and the agency that supported the clinical trial. The results of this study should change medical practice.

Among the 703 patients, researchers examined 337 patients with a prior history of the more serious stromal keratitis. Acyclovir reduced the rate of recurrences of stromal keratitis from 28 percent to 14 percent, a difference of 50 percent between the two groups. The study medication caused no serious side effects.

What Is Ocular Herpes

Herpes simplex keratitis occurs when the herpes simplex 1 virus infects the cornea or the white part of the eye. The term keratitis means an inflammation of the cornea. The virus first attacks the corneal epithelium, the thin outer layer of the cornea. This layer plays an important role in protecting the eye. It blocks intrusion from foreign materials and provides a smooth surface to absorb oxygen and cellular nutrients that are delivered through the tear film that lies on top of it. The epithelium also contains many nerve endings its very sensitive.

When a virus attacks the cornea, this outer epithelium layer becomes red, irritated, and painful, because the nerve endings serving the cornea also become infected. The extent of damage can vary widely, sometimes healing by itself within a week to ten days. If the virus recurs at a latter time, however, the results can be more serious, including ulcers and lesions that extend to the stroma layer of the cornea. The stroma layer is a thick layer comprised of water, layers of protein fibers, and cells delivering nourishment.

There are two major types of this virus. Type I is the most common and is not sexually transmitted, while Type II typically infects the genitals. Of the two types, Type I more commonly affects the eye, often resulting in symptoms such as eye infections, cold sores, or blisters.

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If Just The Eyelids Or The Thin Lining Of The Eyelid Are Affected

These infections will usually settle on their own in 1-3 weeks. No treatment may be advised. You are likely to be kept under review, until the infection clears, to check that the cornea does not become infected.

Note: if you have herpes simplex eye infection, you should not wear contact lenses until 24 hours after your symptoms and the infection have completely gone away.

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.

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If The Top Layer Of The Cornea Is Affected

Treatment is with antiviral eye ointment or drops . These do not kill the virus but stop it from multiplying further until the infection clears. You should take the full course exactly as prescribed. This is often several times a day for up to two weeks. The aim is to prevent damage to the transparent front part of the eye .

How Is Herpes Eye Disease Treated

Your treatment for herpes eye disease may vary according to its severity, the part of your eye affected, and your response to previous therapy. Possible treatments include:

• Antiviral ointment for your eyelids
• Antibiotic ointment for your eyelids
• Antiviral drops for your eyes
• Antiviral medicines taken by mouth
• Antibiotic drops for your eyes
• Steroid drops for your eyes

Most of these treatments are relatively short-term. You may also need to take oral antiviral medicine on a long-term basis to help prevent future flare-ups.

Some complications of herpes eye disease may need their own specific treatment.

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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:

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.

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What Is The Prognosis For A Cat Diagnosed With Herpes Viral Conjunctivitis

There is no cure for herpesvirus infections. The therapeutic goal is to reduce the frequency and severity of recurrences. Most cats respond well to medical management and lead relatively normal lives. Minimizing the chance of infection, feeding a premium diet, supplementing the diet with L-lysine daily, reducing stressful situations, and proper vaccination against preventable causes are your cat’s best defense.

“There is no cure for herpesvirus infections.”

It is important to note that many cats fully recover from herpes viral conjunctivitis and become carriers of the virus for life. Other cats may contract FHV-1 infection from contact with an infected cat. It is common for entire households of cats to be infected with FHV-1 and experience periodic outbreaks.