Eye Herpes – Types, Symptoms & Treatment

What is Herpes Eye Disease?

Eye herpes is also known as ocular herpes. It’s an infection caused by the herpes simplex virus type 1 (HSV-1), which is also the cause of cold sores. It affects about 24,000 people in the United States each year.¹

The most common type of eye herpes is herpes simplex virus keratitis, which affects the cornea (transparent protective outer layer). If left untreated, HSV keratitis can lead to vision changes and blindness. It’s considered a significant cause of blindness worldwide.

There are two types of eye herpes that affect the cornea:

• Epithelial keratitis is an infection of the cornea’s outer layer and accounts for 50%-80% of eye herpes cases.³
• Stromal keratitis is an infection of the deeper layers of the cornea (called the stroma) and can lead to scarring and vision loss.

In addition to the cornea, HSV can infect other parts of the eye, including:

• Sclera (white part of the eye)
• Conjunctiva (clear tissue covering the eyelid and white of the eye)
• Iris (colored part of the eye)
• Retina (the layer at the back of the eye, although this is rare)

Less common herpes viruses include the herpes simplex virus type 2 (HSV-2), which causes genital herpes, and the varicella-zoster virus (VZV), which causes chickenpox.

Eye Herpes Symptoms 

Physical signs and symptoms of herpes simplex eye infections include:

• Eye pain in and around one eye
• Increased eye redness
• Foreign body sensation (feeling like something is in the eye)
• Swelling and inflammation of the eyelids (blepharitis)
• Cloudiness of the cornea
• Redness, rash, or sores on the eyelids similar to poison ivy blisters
• Flu-like symptoms (fever, feeling unwell)
• Increased tearing 
• Clear discharge
• Headache
• Sensitivity to light
• Decreased vision 

Eye Herpes vs. Pink Eye

An ocular herpes simplex virus infection shares common signs and symptoms with another common eye infection called conjunctivitis (pink eye), 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

When to See a Doctor

You should seek medical treatment if you have any eye infection signs or symptoms. Delay in treatment can lead to vision changes and even blindness.

If you wear contact lenses, you should dispose of them and confirm with an eye doctor when it is safe to wear them again.

Diagnosis

A herpes simplex eye infection is diagnosed by an eye specialist (ophthalmologist or optometrist) or a primary care physician. 

Confirming a herpes virus infection diagnosis includes:

• Taking a detailed medical history (past or current medical conditions, medications)
• Discuss symptoms and level of pain
• Ask about contact lens usage

The eye doctor will also conduct a detailed eye exam to assess the following:

• Visual acuity to measure distance vision and clarity
• External eye examination to look for signs of infection on the outside of the eye (discharge, redness, swelling, blisters)
• Slit-lamp biomicroscopy using magnification to look inside of the eye
• The fluorescein eye stain test using a special dye to examine the cornea 
• Eye culture swab to be sent to a lab or confirm the presence of HSV under a microscope

Treatment

While HSV is a dormant virus with no cure, several treatment options for herpes keratitis flare-ups are available.

Treatment will depend on the severity and typically includes topical or oral antiviral medications:

• Zirgan (ganciclovir 0.15%) are topical antiviral eye drops used 5 times daily until symptoms resolve
• Viropic (trifluridine 1%) are topical antiviral eye drops used 9 times daily until symptoms resolve
  Zovirax (acyclovir) is an oral antiviral taken 5 times daily for 7 to 10 days
• Valtrex (valacyclovir) is an oral antiviral taken 2 times daily for 7 to 10 days

It is essential to follow instructions when taking antiviral medication. It is critical to finish the entire course of treatment to prevent virus reactivation. 

Complications

Herpes simplex keratitis infections are usually mild and clear up after treatment. 

However, rare cases may be more serious, especially if left untreated, causing complications including:

• Scarring of the cornea 
• Bacterial or fungal infection
• Glaucoma (optic nerve damage caused by increased eye pressure)
• Vision loss and changes
• Blindness
• Recurring HSV infections

Outlook

Most cases of ocular herpes are mild and respond well to treatment. However, multiple recurrences can be an issue⁸.

Some people with recurrent cases can benefit from prolonged antiviral treatment, such as:

• Proactive long-term oral antiviral treatment for recurrent epithelial keratitis
• Long-term steroid eye drops in combination with antiviral medication for recurrent stromal keratitis

What Does Eye Herpes Look Like?

When an eye is infected with HS

V, it is typically swollen, the whites of the eye are red, and ulcers or blisters develop on the eyelid. 

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Increased tearing and clear discharge are also signs of an eye infection. 

How Does Someone Get Eye Herpes?

HSV-1 and VZV are both common infections, with 90% of the general population exposed during childhood. Since most herpes cases are asymptomatic, many people are unaware they are infected.⁵

Type 1 herpes is transmitted through saliva or skin-to-skin contact with someone who is shedding the virus.

After the initial infection, the viruses that cause eye herpes can lay dormant in the body for long periods. Most cases of eye herpes are a reactivation of a dormant infection that can be triggered and reactivated by:

• Certain medications
• Stress
• Changes in hormone levels
• Menstruation 
• Fever
• Injury or trauma to the body
• Ultraviolet light exposure (sun and tanning beds)

Prevention

Preventing the spread of HSV and other viruses that cause ocular herpes is linked to good hygiene practices, including:

• Avoid touching your eyes if you have cold sores
• Don’t share makeup or eye drops with others
• Wash your hands frequently
• Complete the course of antiviral treatment as prescribed
• Keep contact lenses clean 

Summary

Eye herpes is typically caused by the herpes simplex virus type 1 (HSV-1), a common virus that most people are exposed to in childhood that remains dormant in the body. 

Ocular herpes is when the virus reactivates, causing eye redness, pain, eyelid blisters, and inflammation. 

Most cases of eye herpes are mild, responding well to antiviral medicines. If untreated, ocular herpes can lead to corneal scarring, vision changes, and even blindness.