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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What are the possible risks and complications of untreated herpes eye infections?

In the worst case scenario, untreated herpes eye infections lead to blindness, chronic pain, and loss of the eye. Aggressive treatment is aimed at reducing the chances of scarring, eye pressure problems, and direct damage to the eye tissues.

What is the prognosis of herpes eye infections?

Most HSV eye infections that are limited to the outer layer of the cornea resolve within a couple of weeks with antiviral therapy, leaving little or no permanent damage. HSV infections of the deeper tissue layers may have a higher complication rate due to inflammation.

With HZV and shingles, the keratitis may also resolve over a couple of weeks with antiviral therapy. However, it is not uncommon for a painful burning sensation to linger in the area of the skin rash for months or even years. This is referred to as postherpetic neuralgia and sometimes responds to neurologic medications aimed at suppressing signals from the pain nerves.

Both types of herpes eye infections can leave residual corneal scarring that can blur the vision. In some cases, this can be corrected with surgery. Damage to the corneal nerves can also lead to chronic numbness of the cornea, causing dry eye and, in advanced cases, predisposing to dry-eye related corneal erosions or ulcers. In these cases lubricating drops, punctal plugs, and sometimes eyelid surgery may help protect the cornea.

Unfortunately, both HSV and HZV ophthalmicus can recur with unpredictable frequency in either eye. Frequent recurrences should warrant a general medical checkup to rule out any underlying condition that may be weakening the immune system. However, in many cases it is the virulence of the particular virus strain that determines its activity level.

Medically Reviewed by a Doctor on 1/8/2016
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