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What Does Eye Herpes Look Like?
Eye herpes can cause uncomfortable symptoms, including redness, light sensitivity, and the feeling of something in the eye. Some people may also develop sores on the eyelids.
Recurrent infections can increase the risk of complications, such as corneal scarring, secondary glaucoma, and retinal detachment.
This article examines the types of herpes that can affect someone's eye, including their symptoms, diagnosis, and treatment options.
There are two major types of HSV:
A person will typically contract either form of the virus after skin-to-skin contact with someone who already has herpes. The virus may lay dormant in the nerve cells and can travel along the nerves to the eye upon activation.
The AAO estimates that 90% of people are exposed to HSV-1 in their lifetime, typically as children.
When a person gets herpetic eye disease, they can experience a variety of symptoms. These can occur in both eyes, but they may affect one eye more than the other.
Some of the symptoms depend on the affected part of the eye. Examples of these symptoms include:
Sometimes, people may also experience herpes sores on top of the eyelids. These may resemble a rash with blisters. The blisters will form crusts that usually heal within 3–7 days.
If the herpes virus affects the cornea, the inside of the eye, or the retina, a person may experience changes to their vision. Typically, eye herpes does not cause a lot of pain, even though a person's eye may look painful.
Conditions with similar symptoms
HSV symptoms affecting the eye may be similar to those of the varicella-zoster virus, which causes chickenpox.
Reactivation of the varicella-zoster virus can cause herpes zoster, also known as shingles. This causes vesicles, small blisters, on the forehead and scalp, which can spread to the eye on the same side.
Another condition that can have similar symptoms is pinkeye, which is also known as conjunctivitis.
The herpes virus can spread via the nasal secretions or spit of a person with the infection. The likelihood may be higher when a person has a cold sore.
The virus within the secretions can then travel through the body's nerves, which can include those in the eye.
In some cases, the virus enters the body and does not cause any problems or symptoms. Doctors describe this form of the virus as lying dormant.
Certain triggers can cause a dormant virus to start reproducing and cause eye irritation. Examples of these triggers include:
The herpes virus can be highly contagious. However, not everyone who contracts or comes into contact with the herpes virus will get eye herpes.
Ophthalmologists, or eye doctors, diagnose herpetic eye disease by taking someone's medical history and asking about their symptoms. They may ask when the person first noticed their symptoms and if anything makes them worse or better.
The ophthalmologist will conduct a physical examination of the eye. HSV causes dendrites, a branching pattern, on the cornea, so the examination may involve a special microscope known as a slit lamp to visualize the eye's surface and, potentially, the eyelid.
These professionals can usually diagnose eye herpes by looking at the sores. If the infection has reached the deeper layers of the eye, they will need to use special instruments to measure the eye pressure. They may also need to inspect the deeper eye layers.
Laboratory testing for HSV of the eye is uncommon.
For the most part, eye herpes affects the transparent front part of the eye. This condition is known as epithelial keratitis.
If eye herpes affects the deeper layers of the cornea, it is known as stromal keratitis. This condition is more concerning to eye doctors because it can cause scarring on the cornea, which can permanently affect a person's vision.
Treatment of herpes keratitis depends on its severity. Doctors will usually treat a mild infection with topical and oral antiviral medication.
Eyelids
Doctors may prescribe topical ointments, such as an antiviral ointment, for a person to apply gently to their eyelids.
Outer eye layers
If the eye herpes only affects the outermost layers of the eye, a doctor may prescribe an antiviral eye drop or an oral antiviral medication, such as acyclovir (Zovirax). These help reduce the effects of the virus and could reduce the duration of symptoms.
However, some eye drops can worsen symptoms, so people should always consult an ophthalmologist.
Deeper eye layers
If the herpes virus has affected deeper layers of the eye, an eye doctor may prescribe antiviral eye drops and oral medications.
They may also prescribe steroid eye drops. These help reduce eye inflammation that could lead to increased eye pressure.
However, the AAO highlights that people must take antiviral medication alongside steroid eye drops, as steroids can increase herpes in the body.
As eye herpes can cause further infections, some doctors may recommend taking antiviral medicines regularly to reduce the risk of getting eye herpes again.
Recurrent herpetic eye infections can lead to greater eye damage, which is why doctors aim to prevent their recurrence. Other prevention tips include:
According to a 2021 review, over 1.8 million people experience herpetic eye disease every year. While there is no cure for eye herpes, treatment can reduce the duration of symptoms.
If someone has recurrent eye infections or starts to experience vision loss, they should seek an appointment with an eye specialist for an assessment and advice on additional treatments.
Below are the answers to some common questions about eye herpes.
What does eye herpes look like?
A person with herpes in the eye may experience watery eyes and redness. Some people may also have sores, which look like small blisters, on their eyelid.
How can someone tell if they have eye herpes?
The symptoms of herpes in the eye may be similar to other conditions, such as conjunctivitis and infection with the varicella-zoster virus. People should speak with a healthcare professional for an accurate diagnosis.
Does eye herpes go away?
Early diagnosis and treatment can relieve the symptoms of eye herpes and help it go away faster. The duration of the condition may depend on the person and the severity of the herpes, but symptoms may resolve within 2 weeks with treatment.
Herpes can affect the eyes, causing symptoms such as redness, irritation, and watery eyes. Some people may also have small blisters on the eyelids.
Doctors can prescribe medication, such as eye drops or antifungal medications, to help treat eye herpes and prevent complications that can affect someone's vision.
People should take steps to prevent herpes recurrence, including washing hands regularly and avoiding touching the eye, particularly if they have a cold sore.
Everything You Should Know About Eye Herpes
Eye herpes, or ocular herpes, is caused by the herpes simplex virus (HSV). Your treatment will depend on the severity of the infection and what part of the eye it affects.
The most common type of herpetic eye infection is called epithelial keratitis. It affects the cornea, which is the clear front portion of your eye.
In its mild form, eye herpes causes:
HSV of the deeper layers of the cornea — known as the cornea stroma — can cause severe tissue damage, chronic inflammation, and scarring, all of which can contribute to vision loss.
In fact, eye herpes is the most common cause of blindness associated with cornea damage in the United States and the most common source of contagious blindness in the Western world.
Both mild and severe eye herpes can be treated with antiviral medication, however.
And with prompt treatment, HSV can be kept under control and damage to the cornea minimized.
Typical symptoms of eye herpes include:
In many cases, herpes affects only one eye.
Eye herpes vs. Conjunctivitis
You may mistake eye herpes for conjunctivitis, which is known more commonly as pink eye. Both conditions may be caused by a virus, though conjunctivitis can also be caused by:
An experienced eye doctor can establish the correct diagnosis by collecting a thorough medical history and by performing a detailed eye examination. Careful slit lamp biomicroscopy with the use of a topical inert dye will unveil active herpetic lesions.
A sterile cotton swab can be used to collect a sample for laboratory culture. If you have ocular herpes, the culture will test positive for type 1 HSV (HSV-1). Receiving a prompt, correct diagnosis can help you receive the appropriate treatment.
The most common type of ocular herpes is epithelial keratitis. In this type, the virus is active in the thin outermost layer of cells covering the cornea, known as the corneal epithelium.
As mentioned, HSV can also affect deeper layers of the cornea, known as the stroma. This type of eye herpes is known as stromal keratitis.
Stromal keratitis is more serious than epithelial keratitis because over time and repeated outbreaks, it can damage your cornea enough to require corneal transplantation.
Eye herpes is caused by an HSV transmission to the eyes and eyelids. It's estimated that up to 90 percent of adults have been exposed to HSV-1 by age 50.
When it comes to eye herpes, HSV-1 affects these parts of the eye:
Unlike genital herpes (usually associated with HSV-2), most cases of ocular herpes aren't sexually transmitted.
Rather, it most commonly happens after another body part — typically your mouth, in the form of cold sores — has already been affected by HSV in the past.
Once you're living with HSV, it can't be completely eradicated from your body. The virus can lie dormant for a while, then reactivate from time to time. This means that even though the initial ocular herpes infection resolved with treatment, it can still recur over time due to viral reactivation.
The risk of transmitting the virus to another person from an affected eye is low, however. Antiviral medications help reduce transmission of HSV during an outbreak.
Estimates vary, but approximately 24,000 new cases of eye herpes are diagnosed every year in the United States, according to the American Academy of Ophthalmology.
Eye herpes tends to be slightly more common in men than in women.
If you have symptoms of eye herpes, see an ophthalmologist or an optometrist. These are both doctors who specialize in eye health. Early treatment may improve your outlook.
To diagnose eye herpes, your doctor will ask you detailed questions about your symptoms, including when they started and whether you've experienced similar symptoms in the past.
Your doctor will do a thorough eye exam to evaluate your vision, sensitivity to light, and eye movements.
They'll put eye drops in your eyes to dilate (widen) the iris, too. That helps your doctor see the condition of the retina in the back of your eye.
Your doctor may perform a fluorescein eye stain test. During the test, your doctor will instill an inert orange dye, called fluorescein, onto the outer surface of your eye.
With the use of safe, near-ultraviolet light fluorescein highlights areas of the cornea where the epithelium is unhealthy or absent. These defects produce a familiar stellate pattern on the cornea called a 'dendrite' that can be viewed with the slit-lamp biomicroscope.
Your doctor may take a sample of cells from your eye surface to check for HSV if the diagnosis is unclear. A blood test to check for antibodies from past exposure to HSV isn't very helpful for diagnosis because most people have been exposed to HSV at some point in life.
If your doctor determines you have eye herpes, you'll immediately start taking prescription antiviral medication.
The treatment differs somewhat depending on whether you have epithelial keratitis (the milder form) or stromal keratitis (the more damaging form).
Epithelial keratitis treatment
HSV in the surface layer of the cornea usually subsides on its own within a few weeks.
If you promptly take antiviral medication, it can help minimize cornea damage and vision loss. Your doctor will recommend antiviral eye drops or ointment or oral antiviral drugs.
A common treatment is the oral medication acyclovir (Zovirax). Acyclovir may be a good treatment option because it doesn't come with some of the potential side effects of the eye drops, such as watery eyes or itching.
Your doctor may also gently brush the surface of your cornea with a cotton swab after applying numbing drops to remove diseased cells. This procedure is known as debridement.
Stromal keratitis treatment
This type of HSV attacks the deeper middle layers of the cornea, called the stroma. Stromal keratitis is more likely to result in corneal scarring and loss of vision.
In addition to antiviral therapy, taking steroid (anti-inflammatory) eye drops helps reduce swelling in the stroma.
If you're treating your eye herpes with eye drops, you may need to put them in as often as every 2 hours, depending on the medication your doctor prescribes. You'll need to keep applying the drops for up to 2 weeks.
With oral acyclovir, you'll take the pills five times per day.
You should see improvement in 2 to 5 days. The symptoms should be gone within 2 to 3 weeks.
After a first bout of eye herpes, about 20 percent of people will have an additional outbreak in the following year. After multiple recurrences, your doctor may recommend taking antiviral medication daily.
This is because multiple outbreaks damage your cornea. Complications include:
If the cornea is damaged enough to cause significant vision loss, you may need a corneal transplant (keratoplasty).
Unfortunately, for some individuals, ocular herpes is not curable, but you can still minimize potential damage to your eyesight during outbreaks.
At the first sign of symptoms, call your doctor. The sooner you treat your eye herpes, the less chance there'll be significant damage to your cornea.
Herpes Simplex Symptoms
The herpes simplex virus (HSV) leads to distinctive symptoms when it infects different parts of the body. The most common sites of infection include the skin and mucous membranes of the face. This is termed orofacial herpes. The second most common type of herpes infection affects the genitalia and is known of as genital herpes.
Some of the sites of herpes infection include:
Herpes infection is usually transmitted through skin-to-skin or sexual contact with an infected individual. The virus obtains access to the body through the membranous linings of the mouth, anus and genital tract as well as through contact with infected lesions or when skin abrasions are present. The virus can also be transmitted in the absence of any lesion or cut and when an individual has no symptoms.
Once inside the epithelial cells, the virus rapidly replicates before establishing latent infection in sensory nerve bodies. General symptoms of herpes infection include fever, malaise, headache, runny eyes, swollen glands and feeling unwell. The sores and other symptoms may last up to 20 days and heal without scar formation.
Specific SymptomsHerpes labialis manifests as sores and blisters over the lips and mouth.
Herpes genitalis manifests as clusters of painful and fluid-filled sores over the genitalia. The blisters may be present within the anus or vagina and there may also be vaginal discharge.
Herpetic whitlow refers to a condition where painful sores develop towards the ends of the fingers or thumbs. It may also occur on the toes or on the nail cuticles. Herpetic whitlow is more common among people who practice contact sports such as wrestling or rugby and is also called herpes gladiatorum or wrestler's herpes.
Herpetic keratitis leads to irritation of the eyes with small white lesions appearing. There may also be a gritty or itchy sensation in the eye, along with watering.
Herpetic encephalitis is most common in people with a diminished immune system. There may be an intense headache, convulsions, high fever, rigidity of the neck, unconsciousness, delirium, coma and even death.
In the case of neonatal herpes, the main sites affected are the skin, mouth and eyes.
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