Eye Herpes Disease: Symptoms, Treatment & More

Pain in and around one eye accompanied by redness and blurred vision could be a symptom of pink eye or a stye.

However, in some circumstances, it is a sign of eye herpes and should be looked at by your healthcare provider to avoid more serious health complications. 

Eye herpes, also known as herpes keratitis or ocular herpes, affects over half a million Americans and is regarded as one of the leading causes of blindness.

Caused by the herpes simplex virus (specifically HSV-1), infected persons may experience an initial flare-up, and others may battle with the recurrence of the condition for the rest of their lives. 

In this article, I will discuss eye herpes in detail including the causes, types of eye herpes, symptoms, how it is diagnosed, and treatment options available.

What Is Herpes Keratitis?

Herpes keratitis is an infection of the cornea, the transparent part of the eye, caused by herpes simplex virus.

It is very contagious with no cure, meaning that you may experience flare-ups periodically throughout your life.

After the initial outbreak, the virus lies dormant in your nerve cells and can be reactivated during times of stress, hormonal changes, illnesses, pregnancy, and high sun exposure.

Typically, recurring outbreaks will not be as severe as the initial infection, but you should monitor your symptoms and seek treatment when needed to avoid health complications.

Causes 

Touching a cold sore and then touching the eyes with contaminated fingers can transfer HSV-1 from your mouth to your eyes.

Ocular herpes can infect several parts of your eye:

• Cornea (the clear dome on the front of your eye)
• Retina (the light-sensing sheet of cells in the back of your eye)
• Conjunctiva (the thin sheet of tissue covering the white part of your eye and the inside of your eyelids)
• Eyelids

If you experience a recurrence of HSV-1, such as a cold sore outbreak, you may rarely also develop eye herpes. HSV-2 rarely causes eye herpes, although it can cause genital herpes.

Types

Herpes can infect several areas of the eye resulting in multiple types of eye herpes.

The most important thing to remember about herpes in the eye is that this is a very serious condition that can lead to blindness. If you suspect you have eye herpes, you may have epithelial keratitis.

This is the most common type of eye HSV where the virus is active in the thin outermost layer of the cornea, also known as the epithelium.

HSV can also affect deeper layers of the cornea.

This type of eye herpes is known as stromal keratitis and is more serious, as repeated outbreaks over time can damage your cornea and lead to blindness.

Symptoms

If you suspect you have eye herpes, usually only one eye is affected and you may have any of the following symptoms:

• Eye pain
• Eye redness
• Decreased or blurred vision
• Sensitivity to light
• Watery discharge or tearing
• Rash with blisters on the eyelids
• Feeling that something is in the eye
• Headache

At first glance, eye herpes can easily be mistaken for conjunctivitis, also known as “pink eye.”

If you exhibit any of the above symptoms and have a history of HSV, you should contact your ophthalmologist or optometrist for a physical examination.

Diagnosing Eye Herpes

Since ocular herpes can be misdiagnosed as pink eye, it is important to see an ophthalmologist or optometrist who can assess your medical history and do an eye examination.

This may involve checking your eye with a specialized “slit lamp” to magnify the surface and inside of your eye.

Your provider may also place a dye on the surface of your eye which allows them to closely examine your cornea for signs of infection. 

Often you will not need any other lab testing.

In the event that you do, your provider might send a tiny bit of eye tissue to the lab to further help determine if you have HSV-1.

They may also recommend testing for other eye problems, other STDs, or both.

How common is eye herpes?

In most cases, eye herpes is the result of HSV-1 infection.

According to the World Health Organization (WHO), an estimated 3.7 billion people under the age of 50 (67%) have HSV-1 infection globally and acquired it during childhood.

Over half a million Americans suffer from eye herpes and may experience flare-ups at various periods of their lives. 

Recurrence of the condition

Once you contract herpes, the virus stays in your body for life.

According to the NHS, one in five people with eye herpes will experience a recurrence of the condition within a year.

Symptoms during the initial infection will usually be the most severe.

After that, the virus will transfer from your skin cells into your nervous system where it can lay dormant until it is triggered by certain circumstances.

Most people will only experience one flare-up of the virus.

For those who experience more flare-ups, it’s important to know that the virus can reactivate in the following situations:

• Illness or surgery
• A weakened immune system
• Fever
• Physical or emotional stress
• Intense exposure to heat or sunlight
• Eye injury
• Menstruation
• Pregnancy
• Injury
• A reaction to foods or medicines

Repeated flare-ups of herpes eye disease can cause permanent scarring of your cornea over time and lead to vision loss and in some cases, blindness.

This is why it is important to visit your healthcare provider and get the necessary treatment to manage your symptoms.

Treatment 

Most herpes simplex eye infections will clear up in one to two weeks with prescribed medicine from your ophthalmologist.

The treatment will not cure the condition, but it can help manage the severity and frequency of your symptoms.

The main treatments are:

• Antiviral eye drops or ointment: These stop the virus from spreading and are usually used several times a day for up to two weeks.
• Steroid eye drops: These may be used with antiviral drops to control the infection and reduce inflammation.
• Antiviral tablets: These are taken orally for severe cases and afterward to reduce the risk of another outbreak.
• Surgery: In more severe cases, it may be necessary to scrape the surface of the cornea. If you have severe corneal scarring with vision loss, your eye doctor may advise a corneal transplant to help improve your vision.

Complications 

Most eye herpes cases will resolve within two weeks with proper treatment.

However, if not properly treated, approximately one in four cases are more serious and can put you at a greater risk of the following complications:

• Vision loss
• Scarring of your cornea that could require a cornea transplant
• A bacterial or fungal eye infection 
• Glaucoma 
• Meningoencephalitis (a serious infection of the brain)

Prevention

To avoid spreading HSV-1 to your eye you should consider the following:

• Avoid touching your eyes or the area around your eyes when you are having a herpes outbreak. 
• Avoid contact lenses during a herpes outbreak, or if you absolutely have to wear them, wash your hands frequently and keep your contact lenses and related supplies clean.
• Only use eye drops that have been prescribed or recommended by an eye doctor or healthcare provider. 
• Do not share eye products with anyone.

When to See a Medical Provider

If you have never been diagnosed with HSV, you should visit your healthcare provider at the first signs of infection.

They will be able to do a physical examination and confirm the diagnosis.

The earlier you treat your symptoms, the less likely you are to run the risk of serious complications from ocular herpes.

If you experience frequent eye herpes flare-ups, speak to your doctor about the best treatment plan for you.

Antiviral medications can help reduce the severity and frequency of your symptoms which will also lower your chances of developing more serious complications, such as vision loss, ocular scarring, meningoencephalitis, and glaucoma.

If your doctor can determine what is causing your flare-ups, they may prescribe treatments for the condition causing it.

How K Health Can Help

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