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Eye herpes (ocular herpes)

illustration of eye herpes and its symptoms

What is eye herpes?

Eye herpes — also called ocular herpes — is a viral eye infection caused by type 1 herpes simplex virus (HSV-1). HSV-1 also causes cold sores around the mouth and lips.

In most cases, eye herpes affects the cornea of the eye. In these cases, it’s also called herpes keratitis (in Latin, kerato means “cornea” and itis means “inflammation”).

Eye herpes can affect the superficial cells of the cornea (epithelial herpes keratitis) or the main body of the cornea (stromal herpes keratitis). Stromal herpes keratitis can cause corneal scarring and vision loss.

Less frequently, HSV-1 can cause inflammation of the retina in the back of the eye (herpes retinitis) or inflammation of the iris and associated tissues inside the front of the eye (herpes-related iritis).

What causes ocular herpes?

The type 1 herpes simplex virus that causes eye herpes is typically transmitted by oral-to-oral contact such as kissing or sharing food, eating utensils or a toothbrush.

HSV-1 infects more than half of the U.S. population by the time they reach their 20s, according to the National Institutes of Health (NIH). An estimated 3.7 billion people under age 50 (67%) have HSV-1 infection globally, says the World Health Organization (WHO).

The original HSV-1 infection often causes no symptoms, but for some, the herpes virus produces painful cold sores in or around the mouth that usually last a week or longer. The symptoms gradually fade as the virus retreats into the facial nerves beneath the skin and becomes inactive (dormant).

The virus can remain dormant within the nerves for a lifetime, without causing any apparent problems. But months or even years after infection, certain stressors can reactivate HSV-1, causing cold sores (oral herpes) or eye infections (eye or ocular herpes).

These stressors can include:

  • Emotional upset

  • Excessive exposure to sunlight

  • Fever

  • Major dental or surgical procedures

  • Trauma

Having a weakened immune system (for example, if you’re undergoing chemotherapy) can also put you at increased risk of HSV-1 reactivation, possibly leading to an outbreak of ocular herpes.

Eye herpes symptoms

Various signs and symptoms are associated with an ocular herpes outbreak. You may experience inflammation of the cornea, which can cause irritation or sudden and severe ocular pain. The cornea can also become cloudy, leading to blurry vision.

Other characteristics of eye herpes include:

Ocular herpes usually affects only one eye, but both eyes can be affected.

Left untreated, eye herpes can cause a corneal ulcer and scarring of the cornea that can cause permanent vision loss.

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Eye herpes treatment

If you have ocular herpes, your eye doctor can prescribe antiviral medication to help control the virus and prevent damage to your cornea, says the National Eye Institute. These may be in the form of medicated eye drops, ointments or oral medications, depending on the location and severity of your eye herpes.

Examples of antiviral medications for ocular herpes include:

  • Trifluridine eye drops (Viroptic)

  • Ganciclovir ophthalmic gel (Zirgan)

  • Vidarabine ointment (Vira-A)

  • Acyclovir oral medication (Zovirax)

Be sure to carefully follow your eye doctor’s instructions for the treatment of your eye herpes and use all medications exactly as directed.

Although eye herpes has no cure, treatment can prevent eye damage, avoid vision loss and help control future outbreaks.

If you have corneal scarring and vision loss from ocular herpes, a cornea transplant surgery (keratoplasty) can often restore some or all of your eyesight.

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Jessica Hill and Charles Slonim, MD, also contributed to this article.

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