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Eye Herpes

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Causes, Symptoms, Transmission, and Treatment of Eye Herpes Explained.

There are two types of herpes simplex viruses – HSV 1 and HSV 2.

While both can affect either the mouth or the genitals, HSV 1 is generally associated with oral herpes, and HSV 2 is generally associated with genital herpes.

As a result, many people believe HSV-2 to be the "Bad Herpes," while HSV-1 (the most common cause of cold sores) is considered "Good Herpes."

Unfortunately, HSV-1 may be the more serious of the two, because HSV-1 can travel from the mouth and affect the eye, in a condition known as both "eye herpes" and "ocular herpes simplex."

What is Eye Herpes?

The National Eye Institute, along with NIH, created a study known as the Herpetic Eye Disease Study.

They found that as many as 450,000 Americans suffer from ocular herpes, and 46,000 either get a new infection or have a recurrence every 12 months.

Eye herpes is not a separate form of herpes. It is a side effect of HSV-1, generally known as "oral herpes" or "cold sores."

Eye herpes can be a serious condition. Not only can the blisters be painful – in some people ocular herpes can cause permanent blindness. There are four different types of eye herpes. These include:

Types of Eye Herpes

Herpes Keratitis – Keratitis is the most common type of eye herpes. NIH estimates that herpes keratitis affects roughly 40 – 50% of all of those suffering from ocular herpes. Herpes keratitis will generally not cause blindness or any damaging scars. Herpes Keratitis usually only affects the top layer of the cornea.

Iridocyclitis – Iridocyclitis is not specific to HSV-1 (it can also be caused by shingles), but it is a type of inflammation that cause be caused by eye herpes. While it doesn't generally lead to blindness, Iridocyclitis is considered a very serious condition, because the symptoms can be very painful.

Herpes Retinitis – Herpes retinitis refers to an HSV-1 ocular herpes outbreak that affects the retina. This is not generally known to cause blindness and is fairly rare, but it can damage the retina on rare occasions and affect overall vision.

Herpes Stromal Keratitis – Stromal keratitis is related to basic herpes keratitis. Stromal keratitis occurs when the herpes outbreak affects a deeper layer than the top layer of the cornea and can be very dangerous, leading to corneal scarring that may result in permanently blurred vision and blindness.

While blindness is not a common symptom of ocular herpes, it is a present risk. Outbreaks can penetrate deeper layers of the eye and lead to damaging scars that permanently damage the vision of herpes patients.

What Causes Eye Herpes?

Eye herpes is primarily caused by HSV-1. HSV-2 can cause ocular herpes, but the likelihood of transmission is exceedingly rare.

While HSV-1 can be transmitted at any time in a person's life, many men and women catch HSV-1 as children, often because a parent kissed the child while shedding the virus.

There are several ways that HSV-1 can cause ocular herpes:

  • Contact with Your Own Open Sore
  • Contact with Someone Else's Open Sore
  • Traveling up the Nerves

If you have touched an open sore while you're shedding the HSV-1 virus, and you run or touch your eye, it's possible to infect your eye with eye herpes.

If someone is currently suffering from a herpes outbreak and kisses your eye or touches your eye with their sore, it is possible to contract eye herpes.

Still, eye contact with an open sore is rare. The most common cause of eye herpes occurs because herpes itself became dormant within your nerves after the initial infection. While the exact triggering mechanism is not entirely clear (believed to be related to either stress or the immune system), at some point, a small percentage of those with HSV-1 will produce a reaction that triggers ocular herpes.

Once the individual has experienced ocular herpes, 63% will have a recurrence, with 23% experiencing a recurrence within 2 years.

What are the Symptoms of Eye Herpes?

Eye herpes is a non-fatal disease, but the symptoms of herpes can be problematic. Some common symptoms of ocular herpes include:

  • Pain in and around the eye.
  • Open sores/blisters around the eye.
  • Excessive eye tearing.
  • Feeling of dirt in the eye.
  • Sensitivity to light.
  • Blurred vision.
  • Eye redness.
  • Loss of vision.

Symptoms of eye herpes are very similar to other eye conditions. Proper diagnosis is necessary to receive effective treatment.

How is Eye Herpes Diagnosed?

Open sores around the eye make diagnosing eye herpes easier for doctors. However, many ocular herpes simplex patients do not get sores. Rather, all of the symptoms occur within the eye and mimic the symptoms of pink eye. That can make it hard for doctors to diagnose eye herpes.

Feeling as though a foreign body has entered the eye (like sand or dirt) is a common symptom of ocular herpes and may help with diagnosis, as it's less common with other eye disorders.

Similarly, eye herpes causes an abundance of tears, and light sensitivity, both of which are uncommon with pink eye/conjunctivitis.

Doctors may also use a slit lamp to examine the eye and look to see the appearance and extent of the infection. Lab tests may also be necessary for determining a diagnosis.

Is Eye Herpes Contagious?

Eye herpes is very contagious.

HSV-1, the common form of eye herpes, can be passed both from the mouth and the eye. Generally, oral herpes recurs more often and is more contagious, so anyone diagnosed with ocular herpes can assume they may have oral herpes and should be careful about making skin-to-skin contact during outbreaks.

Although very rare, if you have ocular herpes without any accompanying oral or genital herpes symptoms, avoid touching your eye herpes during an outbreak as it is possible to spread herpes to other areas of your body.

Eye herpes is generally only contagious during outbreaks, and eye herpes outbreaks are less common than oral herpes outbreaks. This reduces the contagiousness of the virus, but care and good hygiene are still important.

During an outbreak, avoid allowing the lips or genitals of others to make contact with your eye.

Can Eye Herpes Be Treated?

Although uncommon, it's possible to experience only the primary eye herpes infection and never have a recurrent outbreak. Roughly 30% of all of those that suffer from ocular herpes will only have the primary outbreak. The virus is still present but will remain inactive.

Neither HSV-1 nor HSV-2 can be cured.

Treatments are designed to limit damage to the eye and reduce eye herpes symptoms. The type of treatment for eye herpes depends on the severity of the outbreak and the resulting symptoms:

  • Mild Symptoms

Mild eye herpes is generally treated with antiviral medications, most of which are topical creams. Occasionally the doctor will prescribe anti-viral pills as well to manage the symptoms. Medications like Zirgan, trifluridine, and Zovirax are fairly common.

  • Moderate Symptoms

Anti-viral medication may be more important to reduce the likelihood of permanent damage. The doctor may also monitor the disease to reduce the chances of progression.

  • Severe Symptoms

Severe ocular herpes symptoms often require additional treatments.  Some doctors use corticosteroids, such as Scopace, to reduce the severity of the symptoms, especially in the event of stromal keratitis (the most likely form of eye herpes to cause blindness). If the doctors are concerned, they may also attempt to wipe away some of the infected viral cells directly from the cornea. When the corneal scarring is severe, surgery may be necessary to fix the scar or provide a corneal transplant.

There are also several natural treatment options available to reduce the severity of the symptoms, although additional pharmaceutical medicine may be necessary when the ocular herpes outbreak is severe.

Ocular Herpes Prevention

Because the mechanism that triggers episodes of ocular herpes in those with HSV-1 is not well known, complete prevention is difficult.

The safest way to prevent ocular herpes is to take precautions to avoid contracting any form of herpes.

Those with HSV-1 or those that have a partner with HSV-1 should be careful to avoid rubbing the eyes after touching the virus.

Some studies have linked eye herpes to stress, so avoiding stress may reduce the likelihood of contracting the disease.

Those that have already had a primarily ocular herpes infection should talk to their doctors about avoiding contact lenses. Some small studies have indicated that contact lenses may increase the recurrence of eye herpes, although these studies may have used sample sizes that are too small to draw any conclusions.

Also, avoid over-the-counter steroid eye drops as some of these eye drops may actually increase virus replication. Contact a doctor before using any of these treatments.


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