Herpes on the eye - symptoms, causes and treatment

Herpes zoster on the eye, also known as herpes zoster, is an infection caused by the herpes simplex virus, the Herpes simplex virus. The virus most often responsible for it is HSV-1, which can be transmitted from herpes labialis to the eye by touch. It can involve the conjunctiva, the superficial layers of the cornea, the eyelids and, in more severe cases, the deeper structures of the eye. The condition requires prompt treatment, especially if pain, photophobia or decreased vision occurs.

The herpes virus remains dormant in the body and can cause recurrences, especially with a weakened immune system, stress or UV exposure. The greatest risk to vision is associated with corneal involvement, as untreated herpes keratitis can lead to scarring, chronic inflammation and permanent visual impairment.

Prevention includes boosting immunity, avoiding fatigue, protecting the eyes from UV radiation and hand hygiene. People with a history of herpes should regularly monitor their eye condition with an ophthalmologist, especially if there have been previous recurrences or corneal symptoms.

Opryszczka – co to?

Herpes is an infection caused by the herpes simplex virus, or Herpes simplex virus, which can affect the skin, mucous membranes and delicate eye tissue. Herpes simplex is most commonly responsible for infections in the mouth and eye area HSV-1, while HSV-2 usually causes genital herpes, although in rare situations it can also cause ocular herpes. According to WHO estimates, HSV-1 infection globally affects approximately 3.8 billion people under 50 years of age, which is more or less 64% of this group, so contact with the virus is very common.

Ocular herpes is not just „herpes by the eye”, but an infection that can involve the eyelids, conjunctiva, cornea and sometimes the deeper structures of the eye. The cornea is particularly important, as it is responsible for the correct refraction of light and sharp vision. Its inflammation can cause pain, photophobia and blurred vision.

The causes of ocular herpes are related to both primary infection and reactivation of the virus. Contact with an infected person or touching infected areas increases the risk of the virus being transmitted to the surface of the eye, especially in the case of a weakened immune system. Also of significance is ocular immune system, the local defence mechanisms that protect the surface of the eye. When they are weakened by disease, trauma, chronic stress or other infections, the virus reactivates more easily.

Leczenie opryszczki oka obejmuje leki przeciwwirusowe stosowane miejscowo lub doustnie. Szybkie rozpoczęcie terapii pozwala ograniczyć objawy i zmniejszyć ryzyko powikłań, takich jak trwałe blizny rogówki czy utrata wzroku¹.

Symptoms of herpes zoster on the eye

Herpes can affect the skin around the eye or directly the eyeball. Symptoms depend on whether the virus involves the skin of the eyelids and eye area, the conjunctiva or the cornea. The disease often occurs during periods of a weakened immune system.

Na początku łatwo pomylić ją ze zwykłym podrażnieniem po nieprzespanej nocy, długiej pracy przy komputerze albo kontakcie z wiatrem. Oko może łzawić, piec i sprawiać wrażenie „zmęczonego”, a powieka bywa lekko obrzęknięta. Dopiero pojawienie się pęcherzyków, bólu, photophobia albo pogorszenia widzenia powinno szczególnie zaalarmować. W takiej sytuacji nie warto czekać, aż objawy same ustąpią. Szybka ocena okulistyczna pozwala odróżnić łagodniejsze zapalenie spojówek od zajęcia rogówki.

The first symptoms of ocular herpes may be redness and irritation of the conjunctiva, tearing, swelling of the eyelids, itching and burning of the eye. On or around the eyelid of the eye there may be characteristic herpetic vesicles. They are usually filled with serous fluid, can occur on the eyelid, under the eye or in the corner of the eye, and form painful erosions when they rupture.

More often than not, patients report several complaints at the same time, and their severity depends on how deeply the virus occupies the tissues of the eye.

Symptoms may include:

• redness and irritation of the conjunctiva,
• tearing,
• swelling of the eyelids,
• itching and burning of the eye,
• a sensation of a foreign body in the eye,
• photophobia,
• visual impairment,
• herpetic vesicles on or around the eyelids.

When the virus attacks the cornea, the following can occur herpetic keratitis, which manifests as blurred vision, eye pain, a foreign body sensation and increased sensitivity to light. It can be suspected especially if the redness of the eye is accompanied by photophobia, decreased visual acuity or pain that increases when blinking. On ophthalmic examination, the doctor may find typical corneal epithelial defects, often with a tree-like shape.

Photophobia in ocular herpes zoster results from irritation of the cornea and tissues of the anterior segment of the eye. The cornea is highly innervated, so its inflammation can cause marked pain, tearing and reflex clenching of the eyelids at light. This is because the physiology of the cornea relies on a very dense network of nerve endings that respond rapidly to epithelial damage and inflammation.

Herpetic conjunctivitis is usually manifested by redness, tearing and discomfort. Unlike bacterial inflammation, it is more likely to be unilateral, may coexist with vesicles on the eyelid and usually does not produce the profuse purulent discharge typical of bacterial infection. Ocular herpes zoster usually lasts from a few days to a few weeks, depending on the effectiveness of treatment and the depth of tissue involvement.

W przypadku zapalenia rogówki, światłowstrętu, bólu, pogorszenia widzenia lub poważniejszych objawów konieczna jest szybka konsultacja z okulistą. Wczesne rozpoznanie i leczenie zmniejsza ryzyko trwałych uszkodzeń².

Causes of herpes zoster on the eye

Ocular herpes is caused by the herpes simplex virus. HSV-1 is most commonly responsible, which can be transmitted from herpes labialis to the eye by touch. Less commonly, HSV-2 is the cause, especially when there is transmission of the virus from other areas of the body to the surface of the eye. After the initial infection, the virus goes dormant in nerve cells and can reactivate under favourable conditions.

The HSV-1 virus infects the eye most commonly through direct contact with secretions from herpetic lesions. Infection can occur after touching an active herpes labial lesion and then rubbing the eye with the same hand. Herpes labialis It can therefore transmit to the eye, especially if the blisters are fresh, burst or are touched without subsequent hand washing.

Reactivation of the virus usually occurs as a result of a weakened immune system, stress, exhaustion or UV exposure. Eye trauma, eye surgery, fever, menstruation, other infections and chronic sleep deprivation can also increase the risk of recurrence. The ocular immune system is also important - if the local immunity of the ocular surface is impaired, the virus more easily causes symptoms.

The recurrence is usually not led by a single factor, but by a combination of factors, such as fatigue, sun and active herpes labialis.

The most common factors favouring recurrence are:

• weakening of the immune system,
• stress and fatigue,
• exposure to UV radiation,
• eye injury or ophthalmic surgery,
• fever and other infections,
• chronic sleep deprivation.

Herpetic conjunctivitis is one of the more common forms of ocular herpes. Sometimes there is a papular reaction of the conjunctiva, which distinguishes it from simple conjunctivitis. Corneal herpes is a more serious condition and can lead to permanent deterioration of vision, so an ophthalmological consultation is necessary when corneal involvement is suspected.

To prevent recurrence of herpes on the eye, protect the eyes from UV radiation, do not rub the eyes, take care of immunity and avoid transferring the virus from the mouth or skin to the eye area.

How to treat herpes on the eye?

The treatment of herpes zoster on the eye is based on the use of antiviral drugs in the form of drops, ointments, gels or tablets. Therapy helps to inhibit the multiplication of the virus and reduces symptoms. In cases of herpetic eye inflammation, it is important to implement treatment quickly to prevent serious complications.

Suspicion of ocular herpes requires urgent ophthalmological consultation, as inadequate treatment may worsen the infection and increase the risk of corneal damage. Therapy should be carried out under the supervision of an ophthalmologist, especially if the symptoms involve the cornea, there is photophobia, pain or deterioration of vision.

Diagnosis usually begins with an ophthalmological examination and assessment of symptoms. The ophthalmologist may use slit lamp, which is an ophthalmic microscope that allows a thorough examination of the eyelids, conjunctiva, cornea and anterior part of the eye. On examination with a dye, e.g. fluorescein, the doctor can see typical corneal epithelial defects that suggest herpetic keratitis. This procedure is in line with the practice described by the American Academy of Ophthalmology, among others.

In unclear, severe or recurrent cases, the presence of the virus can confirm the PCR test. It involves taking material from the surface of the eye, conjunctiva or skin lesion and detecting genetic material of Herpes simplex virus. The PCR test is particularly useful when the disease picture is not typical or HSV needs to be differentiated from other causes of ocular inflammation.

The choice of treatment depends on whether the infection involves only the eyelid and conjunctiva or also the cornea and deeper structures of the eye.

In practice, treatment may include:

• local treatment - Ointment or eye gel with either acyclovir 3% or gancyclovir 0.15%,
• oral treatment - acyclovir, valacyclovir or famcyclovir, especially with a more severe course and corneal involvement,
• ophthalmological checks - assessment of healing and risk of complications, especially if the disease involves the cornea.

Acyclovir is a classic and frequently used antiviral drug, available topically and orally. Valacyclovir is a pro-drug of acyclovir, is better absorbed and is sometimes more convenient in dosing, but the choice between acyclovir and valacyclovir depends on the form of the disease, the doctor's recommendations, the availability of the drug and the patient's condition. One formulation should not be considered alone as „stronger” or „better” in every situation. In the Herpetic Eye Disease Study, prophylactic acyclovir at a dose of 400 mg twice daily for 12 months reduced the risk of recurrence of ocular herpes, demonstrating why the treatment regimen should be determined by the doctor.

Domowe postępowanie przy opryszczce oka nie zastępuje leczenia przeciwwirusowego. Może jednak wspierać terapię i ograniczać ryzyko przeniesienia wirusa.

Codzienne zasady higieny są proste, ale mają duże znaczenie dla bezpieczeństwa drugiego oka i osób z otoczenia.

At home it is worth taking care of:

• rest,
• avoiding contact lenses,
• not rubbing eyes,
• use of a separate towel,
• frequent hand washing,
• protecting the eye from intense light.

Do not self-drip your eyes with random preparations, use drops after other people or use steroid medication without the express recommendation of a doctor.

If herpes on the eye worsens, there is severe pain, photophobia, deterioration of vision, purulent discharge, fever or the symptoms involve the cornea, one should not wait for spontaneous improvement. In such a situation, urgent ophthalmological care and sometimes oral treatment or more frequent follow-ups are indicated.

The use of steroids without medical supervision should be avoided, as they may worsen the patient's condition and increase the multiplication of the virus in the active phase of the infection. Steroids are not absolutely banned in all forms of ocular herpes, but can only be used in selected situations, usually with specific inflammation of the deeper layers of the cornea and always together with antiviral treatment and under close supervision of an ophthalmologist.

Do not scratch or squeeze blisters, rub eyes or touch lesions without washing hands. Hands need to be washed frequently, especially after contact with the face or mouth area. Shared towels, eye cosmetics, contact lenses and lens cases should be avoided. Mascara, eyeliner or eyeliner used during the infection is best discarded so as not to increase the risk of reinfection.

Is herpes in the eye dangerous?

Herpes in the eye, also known as herpetic eye inflammation, can be a serious condition if not treated quickly and appropriately. The herpes simplex virus has the ability to attack various structures of the eye, including the conjunctiva, cornea and even the deeper layers of the eye.

One of the greatest risks is damage to the cornea, which can result in impaired vision and, in extreme cases, even loss of sight. Herpetic keratitis is particularly dangerous because, even after the symptoms have disappeared, the virus can reactivate and cause recurrent infections.

Untreated or recurrent infection can lead to serious complications, especially when subsequent episodes involve the cornea.

These include:

• chronic keratitis,
• corneal scarring,
• corneal stroma,
• her sensory disturbances,
• secondary infections,
• recurrent erosions,
• permanent deterioration of visual acuity.

In severe cases, prolonged treatment may be necessary and, with significant corneal scarring, even surgical treatment.

Herpes in the eye can be difficult to distinguish from other conditions, such as simple conjunctivitis, allergic conjunctivitis or a bacterial infection, which is why an accurate diagnosis is important. Particularly alarming symptoms include blurred vision, severe eye pain, photophobia, a foreign body sensation that worsens with blinking, and corneal opacity. Such symptoms require urgent consultation with an ophthalmologist, as prompt antiviral treatment reduces the risk of permanent damage to the eye.

Ważne pytania i odpowiedzi

• Can herpes on the eye pass on to other people?

  Yes, herpes on the eye is contagious, especially during the active phase of infection, when blisters appear on the skin or around the eyes. Contact with the secretions from these lesions is one of the main sources of herpes virus transmission. It is important to avoid touching the eyes and to wash hands thoroughly to prevent transmission of the virus.

• Can you treat herpes on the eye yourself?

  No, self-treatment of herpes on the eye is not recommended. The use of inappropriate medicines, such as steroid drops without medical supervision, can make the infection worse. If ocular herpes is suspected, an ophthalmologist should be consulted as soon as possible to implement appropriate antiviral therapy.

• How long does it take to treat herpes on the eye?

  The treatment time for herpes zoster on the eye depends on its severity. In most cases, therapy lasts between 1 and 3 weeks. However, recurrent infections may require longer monitoring by an ophthalmologist and the use of prophylactic medication to prevent further episodes.

• Can herpes on the eye come back?

  Yes, the herpes virus remains dormant in the body and can reactivate under favourable conditions, such as weakened immunity, stress or UV exposure. Recurrent herpes on the eye is common, so strengthening immunity and avoiding risk factors is important.

• How to protect your eyes from herpes?

  To protect your eyes from herpes, avoid contact with people with an active infection and do not touch your eyes with dirty hands. Wearing sunglasses with UV filters helps prevent reactivation of the virus. Boosting immunity, a healthy diet and avoiding stress also reduce the risk of recurrence.