Herpes simplex eye infection

Patient information from the BMJ Group
Herpes simplex eye infection
If you've got 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 millimetre 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 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.
Medicines
If your infection affects the top layer of the cornea (the epithelium), antiviral eye
ointment should help your eye to heal.
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Herpes simplex eye infection
Most people with 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 spreading.
There's some good evidence that antiviral eye ointment can heal your eye.You'll probably
be prescribed aciclovir (brand name Zovirax).
When you use eye ointment 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 eye ointment.This is sometimes called debridement. But there’s not enough research
to show how well this works.
If you've got an infection of the middle layer of the cornea (the stroma), antiviral eye
ointment plus steroid eye-drops work best to heal the eye.
Steroid eye-drops fight inflammation (swelling). There are many different types of steroid
eye-drops. One example is prednisolone (Predsol, Minims). Research has found that
people who use antiviral eye ointment and prednisolone eye-drops get better faster than
people who use only antiviral ointment.
Steroid eye-drops 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 eye-drops.
Treatment to stop the infection 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 returning.
Taking antiviral tablets for a year can help stop you getting another herpes eye infection.
Antiviral tablets are designed to kill the virus that's causing the infection. An example is
aciclovir (Zovirax). Antiviral tablets can't get rid of the virus altogether, but they may stop
repeated flare-ups of the eye infection.
Research shows taking tablets 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 eye ointment to take for about six months afterwards. This is to stop your
body 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 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 herpes eye infection.
But if you've had one or more attacks, you may get another in 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 UK 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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