Dr. Orwa Nasser MD MPH - Ocular Herpes (Eye Herpes):

Ocular Herpes (Eye Herpes):

Ocular herpes is a viral infection of the eye caused by the herpes simplex virus. It most commonly affects the cornea and is known as herpes simplex keratitis. The virus can remain dormant in the body and reactivate later, causing recurrent infections. Repeated episodes may lead to corneal scarring and vision impairment if not treated promptly.

Symptoms: Symptoms vary depending on the depth and severity of infection.

    ·    Eye redness.

    ·    Eye pain or irritation.

    ·    Blurred vision.

    ·    Sensitivity to light.

    ·    Excess tearing.

    ·    Foreign-body sensation.

    ·    Swollen eyelids.

    ·    Small blisters around the eyelids.

    ·    More severe cases may involve deeper corneal layers and cause significant vision changes.

Causes: Ocular herpes is caused by infection with herpes simplex virus type 1 and occasionally type 2. After initial infection, the virus remains dormant in nerve tissue. Reactivation may occur due to stress, illness, ultraviolet exposure, trauma, or immune suppression.

Diagnosis and Tests:

·    Diagnosis begins with a comprehensive eye examination.

·    A slit-lamp examination evaluates the cornea and surrounding structures.

·    Fluorescein staining may reveal characteristic dendritic corneal ulcers.

·    Corneal sensitivity testing may show reduced sensation.

·    Laboratory testing may be performed in unclear cases.

Management and Treatment: Treatment depends on the severity and location of infection.

·    Antiviral therapy: Topical antiviral eye drops may be prescribed. Oral antiviral medications such as acyclovir or valacyclovir may be recommended. Antiviral therapy reduces viral replication and promotes healing.

·    Treatment of deeper involvement: If stromal inflammation occurs, topical corticosteroids may be carefully used under specialist supervision. Steroids are typically combined with antiviral medication to prevent worsening infection.

·     Management of complications: Recurrent infections may cause corneal scarring. Severe scarring affecting vision may require corneal transplantation. Long-term suppressive antiviral therapy may be recommended for frequent recurrences.

Prognosis: The prognosis depends on severity and frequency of recurrence. Many mild cases heal without permanent damage. Recurrent or deeper infections increase the risk of corneal scarring and vision loss. Early treatment improves long-term outcomes.

Prevention: Complete prevention of recurrence is not always possible because the virus remains in the body.

    ·    Protect eyes from excessive ultraviolet exposure.

    ·    Manage stress and systemic illness.

    ·    Avoid eye trauma.

    ·    Follow prescribed antiviral suppression therapy if recommended.

When Should I See My Healthcare Provider? Seek medical evaluation if you experience eye redness, pain, blurred vision, or light sensitivity.

When Should I Go to the Emergency Room? Go immediately if you develop sudden significant vision loss, severe eye pain, or rapidly worsening symptoms.

What Questions Should I Ask My Healthcare Provider? Is this ocular herpes or another type of keratitis?

    ·    Is the infection limited to the surface or deeper layers?

    ·    Do I need oral antiviral medication?

    ·    What is my risk of recurrence?

    ·    Should I consider long-term suppressive therapy?

Key Takeaways:

    ·    Ocular herpes is caused by herpes simplex virus infection of the eye.

    ·    It commonly presents as herpes simplex keratitis.

    ·    The virus may reactivate and cause recurrent infections.

    ·    Early antiviral treatment reduces complications.

    ·    Recurrent disease may lead to corneal scarring and vision impairment.