Herpes Viral Infections of the Eye

  • Medical Author:
    Patricia S. Bainter, MD

    Dr. Bainter is a board-certified ophthalmologist. She received her BA from Pomona College in Claremont, CA, and her MD from the University of Colorado in Denver, CO. She completed an internal medicine internship at St. Joseph Hospital in Denver, CO, followed by an ophthalmology residency and a cornea and external disease fellowship, both at the University of Colorado. She became board certified by the American Board of Ophthalmology in 1998 and recertified in 2008. She is a fellow of the American Academy of Ophthalmology. Dr. Bainter practices general ophthalmology including cataract surgery and management of corneal and anterior segment diseases. She has volunteered in eye clinics in the Dominican Republic and Bosnia. She currently practices at One to One Eye Care in San Diego, CA.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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How are herpes eye infections diagnosed?

Most of the time the diagnosis can be made based on the symptoms and the signs alone.

Herpes keratitis typically produces a distinct erosion of the outer layer of the cornea. This tiny erosion is called a "dendrite" and has a tree-branching pattern that can be seen by the examiner using an eye drop containing a yellow dye and a blue light. Under a slit-lamp microscope the eye doctor can look for further clues to distinguish between an HSV and an HZV keratitis, but in either case, the initial antiviral treatment is the same.

Close examination of the other eye tissues (including the skin, conjunctiva, anterior chamber, iris, retina, and more) also offers additional clues to make the diagnosis as well as helps tailor treatment. In questionable cases, a culture can be obtained to confirm the diagnosis.

How are herpes eye infections treated?

Initial treatment is with either topical (drop) or oral antiviral medication. In certain less common cases, intravenous medication is also necessary.

The antiviral drugs currently available suppress the reproduction of the virus, thus reducing the number of active viruses. This may shorten the duration and severity of the infection and possibly reduce the odds of a recurrence.

Unfortunately, there is still no antiviral medication that "cures" one of herpes. The herpes viruses are incorporated into the cells in our nervous system where they remain inactive and quiet ("latent") for months or years. No treatment has been developed to date that can eradicate the viruses when in their latent state.

When the virus becomes "active" for whatever reason, it begins reproducing and its progeny virus travel along a nerve to the site of the infection (at the skin or cornea). The antiviral medications available today only affect these actively replicating viruses, not the latent viruses in the nervous system.

In addition to antiviral medications, antibiotic drops or ointment might be used preventatively to reduce chances of a bacterial infection developing in the area of viral infection. This is because when the cornea is eroded, it becomes more vulnerable to a bacterial infection.

If the eye pressure (intraocular pressure) rises due to internal swelling (inflammation) of the eye or direct herpes virus infection of the trabecular meshwork (the internal drainage channels within the eye), a pressure-lowering medication will also be necessary.

Inflammation of any of the tissues of the eye may require anti-inflammatory medications such as steroids. Herpetic involvement of the middle layer of the cornea (herpetic stromal keratitis), back layer of the cornea (herpetic endotheliitis), and iris (herpetic iritis) are associated with significant inflammation. In some cases, the inflammation is chronic or recurring, requiring several rounds of steroid treatment.

Medically Reviewed by a Doctor on 1/8/2016

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