Herpes simplex eye infections

Herpes simplex eye infections, also known as ocular herpes, are infections of the eye caused by the herpes simplex virus (HSV). The most common type affecting the eye is HSV-1, which typically causes cold sores. Ocular herpes can lead to inflammation and damage to different parts of the eye, potentially resulting in vision loss if not treated promptly.

Types

Ocular herpes can affect various parts of the eye and is classified into several types:

1. Herpes Simplex Keratitis:

   • Epithelial Keratitis: Involves the outermost layer of the cornea. It is the most common form and usually presents as a dendritic ulcer (branching pattern).
   • Stromal Keratitis: Affects the deeper layers of the cornea, potentially leading to scarring and vision loss.

2. Herpes Simplex Blepharitis:

   • Infection of the eyelids, causing sores, swelling, and redness.

3. Herpes Simplex Conjunctivitis:

   • Infection of the conjunctiva, leading to redness, swelling, and discharge.

4. Herpes Simplex Uveitis:

   • Involves inflammation of the uvea (the middle layer of the eye), which can cause eye pain, redness, and blurred vision.

Symptoms

Symptoms of herpes simplex eye infections vary depending on the affected area but generally include:

• Redness: In the white part of the eye or around the eye.
• Pain: Eye pain or discomfort.
• Blurry Vision: Difficulty seeing clearly.
• Tearing: Excessive tearing or watery eyes.
• Discharge: From the eye, which may be clear, yellow, or green.
• Sensitivity to Light (Photophobia): Discomfort or pain when exposed to light.
• Swelling: Around the eye or eyelids.
• Foreign Body Sensation: Feeling like something is in the eye.

Causes

Herpes simplex eye infections are caused by the herpes simplex virus, which can be transmitted through:

• Direct Contact: Touching an active herpes lesion (e.g., cold sores) and then touching the eye.
• Autoinoculation: Spreading the virus from one part of the body to another, such as from the mouth to the eye.
• Reactivation: The virus can remain dormant in the body and reactivate, leading to recurrent eye infections.

Risk Factors

Certain factors increase the risk of developing herpes simplex eye infections:

• Previous HSV Infections: A history of cold sores or genital herpes.
• Compromised Immune System: Conditions or medications that weaken the immune system.
• Stress: Physical or emotional stress can trigger reactivation of the virus.
• Trauma: Injury or surgery involving the eye can precipitate an outbreak.

Diagnosis

Diagnosing herpes simplex eye infections involves:

1. Physical Examination: Checking for signs of infection in and around the eye.
2. Slit-Lamp Examination: Using a special microscope to examine the cornea and other structures of the eye.
3. Corneal Staining: Applying fluorescein dye to highlight corneal ulcers or abrasions.
4. Viral Cultures or PCR: Collecting a sample from the eye to test for the presence of the herpes virus.
5. Blood Tests: Occasionally used to check for antibodies against HSV.

Treatment

Treatment for herpes simplex eye infections aims to reduce symptoms, speed up healing, and prevent complications:

1. Antiviral Medications:

   • Topical Antivirals: Such as trifluridine (Viroptic) or ganciclovir (Zirgan) eye drops.
   • Oral Antivirals: Such as acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir).

2. Corticosteroids:

   • Prescribed cautiously and under close supervision, particularly in stromal keratitis, to reduce inflammation while preventing worsening of the infection.

3. Pain Management:

   • Over-the-counter pain relievers or prescription medications to alleviate discomfort.

4. Supportive Care:

   • Keeping the eye clean and avoiding contact lenses or eye makeup until the infection clears.

Complications

Untreated or severe herpes simplex eye infections can lead to:

• Corneal Scarring: Resulting in permanent vision impairment or blindness.
• Chronic Eye Pain: Due to recurrent infections or nerve damage.
• Glaucoma: Increased eye pressure caused by uveitis or steroid use.
• Secondary Bacterial Infections: Infection complicating the viral infection.

Prevention

Preventing herpes simplex eye infections involves:

• Good Hygiene: Regular handwashing and avoiding touching the eyes with unwashed hands.
• Managing Stress: Stress management techniques to reduce the likelihood of viral reactivation.
• Avoiding Contact with Active Lesions: Refraining from touching cold sores or genital herpes lesions and then touching the eyes.
• Protective Eyewear: Using goggles or glasses in environments where eye injury is possible.

When to See a Doctor

Seek medical attention if you experience symptoms of an eye infection, particularly if:

• You have a history of herpes simplex infections.
• Symptoms worsen or do not improve with initial treatment.
• You experience severe pain, vision changes, or sensitivity to light.

Conclusion

Herpes simplex eye infections are a serious condition that requires prompt diagnosis and treatment to prevent complications and preserve vision. Awareness of symptoms, risk factors, and preventive measures can help reduce the incidence of ocular herpes and its associated impacts on eye health. Regular eye examinations and immediate medical attention for any signs of infection are crucial for maintaining optimal eye health.