Herpes simplex eye infection

Patient information from the BMJ Group
Herpes simplex eye infection
If you have a herpes simplex eye infection it means your eye is infected with the
herpes simplex virus. The infection will probably go away in a couple of weeks.
But there's a chance it could cause more serious problems that might damage
your eyesight.
We've brought together the best and most up-to-date research about herpes simplex
eye infection to see what treatments work. You can use our information to talk to
your doctor and decide which treatments are best for you.
What is herpes eye infection?
Lots of people carry the herpes simplex virus in their body. Usually it doesn't cause
problems. But if the virus infects your eye it can make it red and uncomfortable. Rarely,
it can cause sight problems.
In most people, herpes eye infection is caused by herpes simplex type 1. This is the virus
that causes cold sores on your lips. In some people, herpes eye infection is caused by
herpes simplex type 2. This virus usually causes genital herpes.
Herpes eye infection usually affects the front part of the eye, called the cornea. The
cornea is clear and less than 1 millimeter thick. It protects the rest of the eye.
Usually the infection affects the top layer of the cornea (the epithelium). The infection
may damage the tissue and cause an ulcer. Occasionally it affects the middle layer of
the cornea (the stroma). This is more serious. But in some people the infection affects
only the eyelid or the outside of the eye (the conjunctiva).
What are the symptoms?
You may not get any symptoms, especially the first time you have a herpes simplex eye
infection. But it's important to go to the doctor if you do have symptoms. These include
a swollen eyelid; redness, pain or discomfort in the eye; pain when looking into bright
light; watering eyes; and blurred eyesight.
If your doctor thinks that your symptoms are caused by herpes infection, he or she will
probably refer you to a specialist eye doctor called an ophthalmologist.
What treatments work?
There are some good treatments for herpes simplex eye infection. The treatment you
need depends on which part of your cornea is affected.
Medications
If your infection affects the top layer of the cornea (the epithelium), antiviral eyedrops
should help your eye to heal.
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Herpes simplex eye infection
Most people with a herpes eye infection of the top layer of their cornea get better in a
couple of weeks, even without treatment. But your doctor will probably suggest you have
treatment. This is to stop the infection from spreading.
There's some good evidence that antiviral eyedrops can heal your eye. There are several
different types, including idoxuridine (brand name Herplex) and trifluridine (Viroptic).
Trifluridine seems to work better than idoxuridine.
When you use eyedrops, your eyes may water more than usual or feel itchy and
uncomfortable.
Some doctors wipe away the infected tissue from the cornea before starting treatment
with eyedrops. This is sometimes called debridement. But there’s not enough research
to show how well this works.
If you have an infection of the middle layer of the cornea (the stroma), antiviral eyedrops
plus steroid eyedrops work best to heal the eye.
Steroid eyedrops fight inflammation (swelling). One example is prednisolone (AK-Pred,
Pred Forte). Research has found that people who use antiviral eyedrops and prednisolone
eyedrops get better faster than people who use only antiviral drops.
Steroid eyedrops have side effects. They can make the herpes virus infection more likely
to spread to the top layer of the cornea (the epithelium). So you might get an ulcer there.
You'll need to get your eye checked regularly while you're using these eyedrops.
Treatment to stop the infection from coming back
If you get repeated infections you’re more likely to get damage to your eyesight. So you
may want to try treatments to stop the infection from returning.
Taking antiviral pills for a year can help stop you from getting another herpes eye
infection. Antiviral pills are designed to kill the virus that's causing the infection. An
example is acyclovir (Zovirax). Antiviral pills can't get rid of the virus altogether but they
may stop repeated flare-ups of the eye infection.
Research shows taking pills for three weeks or less doesn’t seem to help.
Other treatments
If your eyesight has been damaged by herpes eye infection your doctor may recommend
surgery. In a corneal graft operation your surgeon cuts away the damaged part of your
cornea and replaces it with a piece of cornea from a donated eye.
You should be able to see better after a few months, once your eye has recovered from
the operation.
You'll be given eyedrops to take for about six months afterward. This is to stop your body
from rejecting the patch of donor cornea.
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Herpes simplex eye infection
What will happen to me?
Your infection will probably go away in a couple of weeks. But there's a small chance it
could scar the cornea, which can damage your eyesight.
In one study of people with a herpes eye infection, less than 1 in 10 people found their
sight was affected, over a period of 30 years.
Your eyesight is unlikely to get damaged the first time you have a herpes eye infection.
But if you've had one or more attacks, you may get another in the future. The more
attacks you have, the more likely you are to get a serious infection that could damage
your eye.
If your cornea has been badly damaged and you can't see properly you may need to
have a corneal graft operation. Herpes eye infection is one of the main reasons why this
operation is done.
This information is aimed at a US patient audience. This information however does not replace medical advice.
If you have a medical problem please see your doctor. Please see our full Conditions of Use for this content. These
leaflets are reviewed annually.
© BMJ Publishing Group Limited 2015. All rights reserved.
Last published: Sep 16, 2015
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