Herpes in your eyes too? Let's learn about Ocular Herpes!

Have you suddenly had a red, painful eye that feels like something is poking you inside? You may also be tearing up a lot. When this happens, we think of it as a simple eye problem. However, sometimes it can be something more serious. Today, we are going to talk about a condition called ocular herpes, which can affect the eyes.

What is ocular herpes?

Simply put, ocular herpes is when the herpes virus affects your eyes. This is a serious condition that can sometimes lead to vision loss if not recognized and treated quickly. That's why it's important to be aware of it. Some people also call it "herpetic eye disease."

Two types of viruses mainly affect this condition:

1. Herpes Simplex Virus (HSV): There are two types of this as well.

• HSV type 1 (HSV-1): This is the type that usually causes cold sores or "fever blisters." HSV-1 is also responsible for most cases of herpes in the eyes. When it affects the eyes, it is called herpes simplex ophthalmicus (HSV-1).
• HSV type 2 (HSV-2): This is the type of herpes that is mainly transmitted sexually. However, it can rarely affect the eyes.

2. Varicella Zoster Virus (VZV): Remember chickenpox when you were a kid? It's the VZV virus that causes chickenpox. After chickenpox, the virus lies dormant in our nervous system. Years later, perhaps in old age, the virus can reactivate and cause a condition called "shingles." If shingles spreads to the eyes, it's called Herpes Zoster Ophthalmicus (HZO).

How common is this eye herpes?

It is estimated that there are about 500,000 people in the United States alone who have ocular herpes caused by the HSV virus. About 58,000 new cases are reported each year. It can occur in people of any age. Since the HSV virus is a very common virus, a large number of people are at risk.

The herpes zoster (shingles) caused by the VZV virus affects about one in 1,000 people in the United States each year. This number increases to one in 100 people over the age of 60. Experts say that between 8% and 20% of these people may develop eye symptoms. The condition is somewhat rare among young children.

What are the symptoms of herpes in the eyes?

The symptoms of herpes in the eyes can vary slightly depending on the virus that caused it. Since these symptoms can often be seen in other eye conditions, it's best to see a doctor for a proper diagnosis. While some symptoms affect the eye itself, others can affect the areas around your eyes. It usually affects one eye, but sometimes both eyes can be affected at the same time.

Symptoms caused by the HSV virus:

• Eye pain.
• Eye irritation and redness.
• Feeling like there is something in the eye (foreign body sensation).
• Photophobia: This means that it is difficult to look at light.
• Tearing from the eyes (Epiphora).
• Swelling or inflammation of the eyelid (Blepharitis).
• "Eye disease" (conjunctivitis), sometimes accompanied by inflammation of the cornea, the transparent front part of the eye (keratoconjunctivitis).
• Fluid-filled blisters (vesicles) or pus-filled blisters (pustules) that appear in clusters on or around the eyelids.
• Corneal ulcers or other changes.

More serious symptoms may include:

• Vision impairment.
• Iritis (inflammation of the colored part of the eye).
• Sudden or rapid loss of vision.

Symptoms caused by the VZV virus (related to herpes zoster - shingles):

The VZV virus can cause many symptoms in the eyes. However, symptoms are also common in the skin around the eyes, especially on the forehead. This virus mainly attacks the nervous system. So, these symptoms appear in the areas where the trigeminal nerve branches in the forehead.

Eye-related symptoms:

• Swelling or inflammation of the eyelid (Blepharitis).
• Swelling of the cornea or conjunctiva.
• Redness or swelling of the outer membrane of the white of the eye (Episcleritis).
• A watery discharge from the eye, especially when there is episcleritis.
• Drooping eyelid (Ptosis).
• Painless loss of vision (this is a rare, but very serious complication ).

Skin symptoms (usually on one side of the face):

• Skin rash.
• Vesicles or pustules appear on the forehead or nose, which burst and form a crust.
• Itching.

People who develop ocular herpes due to VZV may experience general symptoms such as nerve pain , fatigue, and malaise before symptoms appear in the eyes or skin.

What causes herpes in the eyes?

As we mentioned earlier, the two types of herpes simplex (HSV) virus (type 1 and type 2) and the varicella zoster (VZV) virus are the main causes. These viruses are highly contagious . This means that you can easily catch them from other people. However, there are slight differences in the way these two types of viruses are transmitted.

HSV-1 virus

If you touch a cold sore in your mouth and then touch your eye with the same hand, the virus can get into your eyes. Sometimes, the virus can affect your eyes when it first enters your body (primary infection). However, most often, the virus reactivates and travels along the nerves to your eyes, either through your hands or through your skin.

The HSV-1 virus is easily spread from person to person through bodily fluids such as saliva. It can also be spread through direct contact, such as kissing. It can also be spread indirectly by sharing items such as dishes, water bottles, makeup products, and towels.

HSV-2 virus

HSV-2 is mainly a sexually transmitted infection (STI). However, it can rarely be spread through bodily fluids, such as through hands or directly to the face or eyes. Infants and young children can develop herpes in the eyes this way.

Also, HSV-2 can be transmitted from mother to baby during pregnancy or childbirth. This is called "vertical transmission." This is a major way for a newborn baby to develop herpes in the eyes later if they are infected with HSV-2.

Varicella zoster virus (VZV)

Chickenpox is caused by the VZV virus. After chickenpox has healed, like HSV, the VZV virus lies dormant in the nervous system. Years, sometimes decades later, it can reactivate and cause herpes zoster (shingles). Shingles can spread through the nervous system and reach the eyes through the nerves that run near the eyes.

Importantly, although the VZV virus causes both chickenpox and shingles, only shingles causes herpes in the eyes. It is very rare for chickenpox to affect the eyes. However, it is not classified as ocular herpes. Also, ocular herpes is not contagious like shingles on the skin.

Can herpes in the eyes recur?

Yes, it is possible to get eye herpes more than once. There are several risk factors that can contribute to this:

• Stress.
• Fever.
• Ultraviolet laser eye treatments.
• Some medications that are applied to the eyes, for example beta-blockers, corticosteroids, epinephrine, and prostaglandins.
• Menstruation in women.
• Medications or medical conditions that suppress the immune system (if you have herpes in both eyes, it could be an underlying immune system weakness).
• Having a weakened immune system due to another recent infection.

What are the possible complications of herpes in the eyes?

The most serious complication of herpes in the eyes is vision loss or blindness . Both HSV and VZV can affect different parts of the eye. The cornea is most commonly affected, but the uvea, the middle layer of the eye, and the retina can also be affected. Recurrences of the virus can cause scarring and permanent vision loss. That's why herpes in the eyes is a condition that needs to be recognized and treated quickly.

How is herpes in the eyes diagnosed?

Your eye care specialist will carefully examine your eyelids and the skin around your eyes. They will look for things like blisters and discoloration. They will also ask about your medical history and any recent events that may be related to this infection.

If you have not previously been diagnosed with herpes simplex or varicella zoster, there are several ways to test for these viruses. These range from swabs taken from the surface of the eye to blood tests (for antibodies from a current infection or a past infection).

An ophthalmologist can use an eye exam and other methods to determine exactly which parts of your eye are affected and how to treat them. A slit lamp exam, which is part of a routine eye exam, allows your doctor to look inside your eye. This can help determine the best treatment for your condition. You may also need to see a primary care physician (PCP) or another doctor to treat any external effects of HSV or shingles.

How to treat herpes in the eyes? Can it be cured completely?

There is no cure for either herpes simplex virus or varicella zoster virus. However, these viruses can be controlled, preventing their reactivation, and suppressing symptoms.

The main way to control these viruses is with antiviral medications . These work by stopping the virus from multiplying (making more viruses). This can help control an existing infection or a flare-up. There are also some medications that can be taken daily to prevent the virus from reactivating. Some medications are specific to HSV or VZV, while others can be used for both.

These medications are available as intravenous (IV) medications, oral (oral) pills, or eye drops or ointments. Some examples are:

• Acyclovir
• Famciclovir
• Foscarnet
• Ganciclovir
• Trifluridine
• Valacyclovir

Your eye specialist may also prescribe other medications to treat your infection or symptoms. Common ones include:

• Antibiotics: Antibiotics cannot treat viruses. However, when you have a viral infection, your immune system can become susceptible to bacterial infections. Antibiotics can prevent this.
• Anti-inflammatory medications: These medications reduce swelling, inflammation, and inflammation (which can cause other complications) that often accompany infections in or around the eyes.

People with more severe eye damage may need surgery.

Your ophthalmologist will tell you the following:

• What specific treatments do they recommend?
• How can treatment help?
• How to use prescribed medications.
• What are the possible side effects?
• When will you start feeling better?

What to expect if you have herpes in your eyes?

The symptoms of ocular herpes vary depending on the virus that causes it and the parts of the eye that are affected. It is usually very painful . It can also cause uncomfortable symptoms such as sensitivity to light and watery eyes.

If you develop blisters or sores around your eyes or on your eyelids, see a doctor or ophthalmologist as soon as possible . Prompt diagnosis and treatment are important to prevent serious eye complications.

If your child has symptoms of eye herpes, you should see their pediatrician immediately. Eye herpes is the second leading cause of corneal vision loss in children.

What is the outlook for ocular herpes?

Herpes in the eyes is not life-threatening, but it can cause permanent vision loss and other problems. Fortunately, the condition is treatable. Antiviral medications can also reduce the risk of recurrence. Since the virus persists for life, you may need to continue taking these medications.

Can eye herpes be prevented?

There is no 100% way to prevent eye herpes. However, even if you do contract the virus that causes it, there are some things you can do to significantly reduce your risk of developing eye herpes:

• Wash your hands frequently or use sanitizer. This makes it harder for viruses to spread.
• It's best not to share things with others. Oral herpes is most commonly spread through shared items like water bottles, cups, eating utensils, personal hygiene items, and makeup products.
• Avoid contact with anyone who has a sore or blister around their mouth or lips. Avoid kissing or other close contact with anyone who has a sore or blister around their mouth. Avoid contact with others if you have one.
• Get vaccinated. Both chickenpox and herpes zoster (shingles) can affect the eyes. Shingles can cause permanent, severe eye problems and vision loss (and other complications, such as severe nerve pain). Getting vaccinated can greatly reduce that risk. Even if you've had shingles before, you can get this vaccine to reduce your risk of getting it again.
• Manage your condition. If a doctor has diagnosed you with a viral condition that can cause herpes in the eyes, they may recommend antiviral medication to prevent it from recurring.

How can I take care of myself if I have herpes in my eyes?

If you have herpes in your eyes, it's important to get treatment. The sooner you get treatment, the less likely you are to develop serious complications. You should also talk to your doctor about taking antiviral medications to prevent the virus from reactivating and causing a recurrence.

What questions should I ask my ophthalmologist or healthcare provider?

If you have herpes in your eyes, you can ask your ophthalmologist or healthcare provider these questions:

• What virus causes herpes in my eyes?
• What treatments do you recommend?
• Is there any medicine I can take to prevent future recurrences?
• What can I do to prevent this condition from spreading to others?

How does herpes in the eyes look?

Ocular herpes caused by HSV may have symptoms such as:

• Rash on your eyelids or around your eyes.
• Clusters of small blisters surrounded by red skin on the eyelids or around the eyes.
• One or more sores, blisters, or pustules around the eyes.
• Eye discharge.
• Red or bloodshot eye.

Ocular herpes, caused by varicella zoster (VZV), can look similar, but it can have another distinctive feature: skin lesions, blisters, or sores on one side of the forehead. This is because the virus travels through specialized nerves in the forehead and reaches the eye.

Can ocular herpes be spread through fabrics like towels and pillowcases?

Yes, viruses like HSV or VZV can be spread through dirty clothes, pillowcases, towels, and washcloths. Do not share these items with someone who has HSV or shingles. If you have one of these infections, do not share them with others. Also, wash towels and pillowcases daily to reduce the spread of infection. Use separate cloths to wipe infected areas.

Finally, finally, remember this.

The viruses that cause eye herpes are common and spread in many ways. You may feel uncomfortable talking to your doctor about the herpes virus. However, your doctor's focus is on treating you so that you feel better. Starting treatment early can help prevent serious complications and future recurrences. If you have symptoms of eye herpes, or want to talk more about your risk of developing this condition in the future, don't delay seeing an eye specialist. Your eyes are precious, so take care of them!

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