Eye Herpes

What Is Eye Herpes?

Herpes simplex keratitis is an infection of the cornea caused by the herpes simplex virus (HSV). Also known as eye herpes, this illness should be treated by a physician as complications can arise.

What Causes Eye Herpes?

  • Herpes keratitis, commonly known as eye herpes, is an inflammation of the cornea, the clear dome that covers the front part of the eye.
  • Herpes keratitis is caused by the herpes simplex virus. Herpes is a common family of viruses, and most people carry some sort of herpes virus in them for life.
  • The condition is caused by a reactivation of an already present herpes simplex virus. The herpes simplex virus never leaves the body after an initial (or primary) infection.
  • After that primary infection, the virus remains in a dormant stage within the nerves. Sometimes, the virus reactivates and causes further symptoms. It is not known why these viruses can cause keratitis in some people but not others.
  • It usually affects only one eye and is one of the more frequent causes of blindness in one eye in the U.S.

What Are Eye Herpes Symptoms and Signs?

Patients with HSV keratitis may develop the following:

  • Pain
  • Photophobia (light sensitivity)
  • Blurred vision
  • Tearing
  • Redness of the eye

A history of prior episodes will appear in patients with recurrent disease.

The diagnosis of herpes simplex infection is often overlooked because symptoms usually resemble those of common conjunctivitis. Ocular pain is usually not a symptom of common conjunctivitis. The infection may resolve on its own or, especially if the infection reactivates, it can affect the cornea more extensively, and symptoms may be more severe.

Symptoms and signs of a reactivation include eye pain, blurred vision, tearing, redness, and sensitivity to bright light. Rarely, the infection worsens and the cornea swells, making vision even more hazy. The more frequently the infection recurs, the more likely there is to be further damage to the cornea. Several recurrences may result in the formation of deep ulcers, permanent scarring, and a loss of feeling when the eye is touched. The herpes simplex virus may also cause blood vessels to grow into the cornea, and this alone can lead to significant visual impairment.

Eye Diseases: Recognize These Common Eye Conditions

When Should Someone Seek Medical Care for Eye Herpes?

If you have eye pain associated with loss of vision, loss of eye movement, painful eye movement, eye swelling, eye discharge, or severe headache, seek advice from your doctor or an ophthalmologist. It is difficult over the phone for a doctor or a nurse to grade the severity of eye pain and make a diagnosis without examining you. All of the above symptoms are significant findings that need to be evaluated by your primary physician or ophthalmologist immediately.

Because of the specialized nature of eye examination equipment, most eye problems are usually handled best in your ophthalmologist's office. If an ophthalmologist is not available, go to a hospital's emergency department. If the emergency department has the necessary eye equipment, an ophthalmologist may see you in the emergency department after hours.

Questions to Ask the Doctor About Eye Herpes

  • Is there any sign of damage to the eye?
  • Is there any sign of permanent vision loss?
  • What type of follow-up is necessary to make certain my eye heals properly?

What Exams and Tests Diagnose Eye Herpes?

Medical evaluation of patients with eye pain or other symptoms begins with a thorough history and physical examination. The history consists of questions documenting the symptoms in detail.

  • Important questions to be asked and answered include when the pain or other symptoms started, the location of pain, the duration of pain, the characteristics of pain, anything that makes the pain better or worse, what you were doing when the symptoms began, history of contact lens use, and previous eye injuries, infections, or surgeries.
  • Other important questions are whether you have allergies to medications, your current medications, past medical history, past surgeries, family history, and social history.
  • The physical examination pertaining to the eyes may consist of checking your vision, visual inspection of the eye and its surrounding tissue, eye movements, visual fields (peripheral vision), and the pupil's reaction to light.
  • The doctor may use instruments to get a better look at the eye.
    • An ophthalmoscope, which is a special tool for visualizing the eye, is used to examine the back of the eye and to view the optic nerve and blood vessels.
    • A slit lamp is a microscope with excellent illumination and magnification to view the surface of the eye in detail. This instrument allows the evaluation for possible corneal abrasions and ulcerations. It is also used to look into the anterior chamber, which is the area between the surface of the eye and the pupil. In herpes simplex keratitis, there is often a specific detectable abnormality, called a dendrite, on the surface of the cornea. The presence of a dendrite makes the diagnosis of herpes simplex keratitis extremely likely.
    • Eye pressure can be checked using a tonometer on the slit lamp or a device known as a Tono-Pen. These two instruments are used if glaucoma is suspected.
    • The ophthalmologist may also put an anesthetic drop into your eye for both diagnostic and therapeutic purposes. This test helps to determine if the eye pain comes from the surface of the eye or from deeper structures in the eye. In most cases, pain can be relieved by the topical anesthetic if it originates from the surface of the eye.
    • A dye called fluorescein may be put into the eye to detect abrasions, ulcerations, or any corneal defect. A special blue light will be used in conjunction with the fluorescein to check for these problems.
    • Sometimes, the doctor may take a sample from the infected area to identify the virus (viral culture).

Ocular Herpes Symptom

Eye Pain

Eye pain is often described as burning, sharp, shooting, dull, gritty, a feeling of "something in my eye," aching, pressure, throbbing, or stabbing. Sometimes pain originating from the eye is confused with other symptoms, such as a headache, sinus pain, toothache, or a migraine.

Eye pain is a common reason for people to seek medical care from their doctor (or an ophthalmologist, a medical doctor specializing in the diagnosis and treatment of eye diseases).

What Are Home Remedies for Eye Herpes?

Seek medical attention if you have eye pain.

  • Most commonly, home care consists of flushing the eye with water. See the home care section under eye injuries for techniques on how to flush your eye with water.
  • If you think a foreign body is in your eye, do not rub your eye. This can seriously damage the eye by causing more damage to the surface as the foreign body is moved around with rubbing. Do not attempt to remove a foreign body from your eye or someone else's eye. Treatment other than gentle eye irrigation is generally not recommended and should be reserved for ophthalmologists and other medical professionals.
  • For mild cases of eye discomfort, rest your eyes, take over-the-counter pain relievers such as ibuprofen (Advil) or acetaminophen (Tylenol), and avoid bright light.

What Are Medical Treatments for Eye Herpes?

The doctor may prescribe an antiviral eyedrop or gel such as trifluridine (Viroptic) or ganciclovir (Zirgan). Acyclovir (Zovirax), another antiviral drug, can be taken by mouth. Treatment should be started as soon as possible. Infections that cause deep inflammation may require use of corticosteroid drops and drops that dilate the eye, such as atropine (Atreza) or scopolamine (Scopace). Occasionally, to help speed healing, an ophthalmologist may gently rub the surface of the cornea to remove infectious virus and viral antigens that contribute to the keratitis. Since most cases of HSV epithelial keratitis resolve spontaneously within three weeks, the rationale for treatment is to minimize damage and scarring. Antiviral therapy, topical or oral, is an effective treatment of ophthalmic herpes infections. Patients with frequent recurrences of ocular HSV may be placed on a long-term regimen of oral antiviral medication at a maintenance dose to reduce this frequency.

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Follow-up After Treatment of Eye Herpes

Follow-up care usually depends on the severity of the eye problem. Signs and symptoms of recurrence of herpes simplex keratitis are similar to the first episode. Return to your ophthalmologist or the emergency room if you have increased eye pain, any loss of vision, increased eye discharge or redness, or swelling around the eye. Patients with HSV keratitis need to be monitored closely until the disease is inactive. Any suspicious corneal cloudy area (infiltrate) in the presence of HSV epithelial keratitis should be cultured for possible secondary bacterial, fungal, or parasitic infection and then managed with appropriate topical agents.

Is It Possible to Prevent Eye Herpes? What Is the Prognosis of Eye Herpes?

Contact lens wear, although not contraindicated in patients with previous HSV keratitis, should be used with caution. Patients should understand that contact lens wear may increase the risk of secondary corneal infection with HSV epithelial keratitis. They should be instructed to discontinue contact lens wear at the earliest symptoms of HSV keratitis recurrence.

Herpes simplex keratitis often causes no permanent visual loss but should be treated by a doctor as complications can arise and they can be severe.

Where Can People Find More Information on Eye Herpes?

American Academy of Ophthalmology

Reviewed on 10/31/2017


Kaye, S. and Choudhary, A. "Herpes Simplex Keratitis." Prog Retin Eye Res 25.4 Jul7 2006:355-380.

Wang, J.C. "Herpes Simplex Keratitis." Aug. 7, 2009 eMedicine. <http://emedicine.medscape.com/article/1194268-overview>.

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