Table of ContentsView AllTable of ContentsTypesSymptomsCausesDiagnosisTreatmentPrognosis
Table of ContentsView All
View All
Table of Contents
Types
Symptoms
Causes
Diagnosis
Treatment
Prognosis
Approximately 24,000 new cases of eye herpes are diagnosed in the United States each year, and an estimated 1 million new cases per year are diagnosed globally.Men are slightly more likely to get eye herpes than women.
The area of the eye affected depends on the type of eye herpes. Usually, the cornea (the normally clear dome that covers the front part of the eye) is affected, but eye herpes can reach the inside of the eye or the retina (the thin layer of tissue that lines the back of the eye on the inside).
Eye herpes can also cause inflammation of the eyelids, theconjunctiva(the clear tissue covering the white part of the eye and the inside of the eyelids), or theiris(the colored part of the eye that controls the amount of light entering the eye). Eye herpes cannot be cured, but it can be managed.
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Types of Eye Herpes
There are two main types of eye herpes. Epithelial keratitis is the more common form of eye herpes, but stromal keratitis is more serious and can lead to blindness.
Epithelial Keratitis
Epithelial keratitis accounts for an estimated 50%–80% of all ocular herpes infections.HSV epithelial keratitis affects the outermost layer of the cornea called the epithelium. The virus destroys corneal epithelial cells as it replicates.
Stromal Keratitis
There are two types of stromal keratitis: stromal keratitis without ulceration and HSV stromal keratitis with ulceration.
Stromal keratitis without ulceration:
HSV stromal keratitis with ulceration:
Herpes Zoster OphthalmicusThe herpes zoster virus (which causes chickenpox and shingles) can also cause eye herpes.Like the herpes simplex virus, the herpes zoster virus stays dormant in the body once contracted, and you can have flare-ups, periods of reactivation and worsening symptoms.Symptoms ofherpes zoster ophthalmicusare similar to HSV eye infections but can also include:Redness, rash, or sores on the eyelids and around the eyes (especially on the forehead) similar in appearance to poison ivy or poison oak blisters that turn into scabs over one to two weeks; a milder rash in younger people than in older peopleSwelling and cloudiness of the corneaFlu-like symptoms (low-grade fever, generally feeling unwell)Tingling and numbness in the forehead before the rash appears
Herpes Zoster Ophthalmicus
The herpes zoster virus (which causes chickenpox and shingles) can also cause eye herpes.Like the herpes simplex virus, the herpes zoster virus stays dormant in the body once contracted, and you can have flare-ups, periods of reactivation and worsening symptoms.Symptoms ofherpes zoster ophthalmicusare similar to HSV eye infections but can also include:Redness, rash, or sores on the eyelids and around the eyes (especially on the forehead) similar in appearance to poison ivy or poison oak blisters that turn into scabs over one to two weeks; a milder rash in younger people than in older peopleSwelling and cloudiness of the corneaFlu-like symptoms (low-grade fever, generally feeling unwell)Tingling and numbness in the forehead before the rash appears
The herpes zoster virus (which causes chickenpox and shingles) can also cause eye herpes.
Like the herpes simplex virus, the herpes zoster virus stays dormant in the body once contracted, and you can have flare-ups, periods of reactivation and worsening symptoms.
Symptoms ofherpes zoster ophthalmicusare similar to HSV eye infections but can also include:
Eye Herpes Symptoms
Symptoms of eye herpes include:
Eye Herpes vs. Pink Eye
Symptoms such as redness, pain, eyelid swelling, or discharge from the eye can occur with both eye herpes andpink eye (conjunctivitis), so eye herpes is sometimes mistaken for pink eye.
Pink eye can affect one or both eyes. While it is possible for eye herpes to occur in both eyes, it usually appears in just one eye. If the infection recurs within a year, it’s more likely to be viral rather than bacterial, or it may be from chemical exposure.
Healthcare professionals usually make a diagnosis ofpink eyewithout doing a viral or bacterial culture. Occasionally, this leads to a missed eye-herpes diagnosis. If you have been diagnosed with pink eye, but it doesn’t seem to be clearing up with or without treatment, book a follow-up with your healthcare professional to rule out eye herpes.
HSV-1 is very common. Approximately 3.7 billion people under age 50 worldwide have HSV-1 infection.Seropositivity(antibodies found in the blood for a particular infection) for HSV-1 has been reported in 65% of Americans.
Most people in the United States will contract HSV-1, usually in childhood. Many people are unaware they carry the virus and it can remain dormant (inactive and asymptomatic) in the body indefinitely.
HSV is typically infectious during the five to 10 days the skin lesions are healing, as well as during asymptomatic shedding in saliva.Unlikegenital herpes, eye herpes is not sexually transmitted.
There are some key differences between HSV-1 and HSV-2:
Is common, affecting approximately 3.7 billion people under age 50 (67%) globally
Usually acquired during childhood
HSV-2Almost exclusively transmitted through genital-to-genital contact (sexually transmitted) and causes genital herpes (genital or anal area)Is less common, affecting approximately 491 million people aged 15–49 (13%) globallyUsually transmitted once sexually active
Almost exclusively transmitted through genital-to-genital contact (sexually transmitted) and causes genital herpes (genital or anal area)
Is less common, affecting approximately 491 million people aged 15–49 (13%) globally
Usually transmitted once sexually active
The eye specialist will take a health history and have a discussion of symptoms, including the items in the lists that follow.
Ocular symptoms:
Contact lens history:
Review of other ocular and medical history:
The eye-care specialist will also perform an eye exam that includes checking for light sensitivity, vision, and general health.
Diagnostic tests and procedures the eye specialist may use include:
What Does Herpes Look Like?
The treatment for eye herpes depends on the type, location, and severity of the infection.
Epithelial keratitis usually responds well to treatment and has no lasting major complications.
Treatment for epithelial keratitis may include:
Topical Antivirals
The most common topical antiviral agents for treating epithelial keratitis include:
Zirgan is often the first choice of topical treatment. While Viroptic is effective, it is known to be toxic, which can delay corneal healing.
Oral Antiviral Medications
Oral antiviral medications used to treat dendritic epithelial keratitis include:
Geographic epithelial keratitis, another subset of epithelial keratitis, may require higher doses and a longer treatment period.
Oral antivirals are less expensive and have a more manageable dosing schedule than topical antivirals, so they are often a first-choice treatment. Oral antivirals should be used with caution in patients with kidney or liver disease.
Corneal Epithelial Debridement
This treatment involves wiping infected cells off the cornea with a dry, cotton-tipped applicator.Debridement removes approximately 90% of the virus in the eye. It can be combined with antiviral treatment.
What Are Steroid Eye Drops?
Eye herpes does not currently have a cure, but it can usually be managed without long-term complications. Eye herpes usually clears up with treatment in about one to three weeks.
The recurrence of ocular herpes is a concern.Those who have recurrent issues of live virus (such as with epithelial keratitis) may need to take long-term oral antivirals proactively.People who have recurrent stromal keratitis may need to take long-term steroid drops with either oral or topical antivirals.
If the eye herpes infection goes untreated or doesn’t respond to treatment, serious complications can occur such as:
The earlier treatment is started, the less risk there is for serious complications.
Is There a Vaccine for Eye Herpes?
While there is not currently a vaccine to prevent eye herpes, studies are being conducted into one.
Summary
A Word From Verywell
If you have symptoms of eye herpes—even if you think it may just be pink eye—see your healthcare professional or eye-care specialist for a proper diagnosis and treatment plan. A doctor can prescribe the necessary medications to help heal you.
16 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Ophthalmology.Herpes simplex virus keratitis: A treatment guideline - 2014.The University of Illinois College of Medicine.Ocular herpes simplex.Zhu L, Zhu H.Ocular herpes: The pathophysiology, management and treatment of herpetic eye diseases.Virologica Sinica. 2014;29(6):327-42. doi:10.1007/s12250-014-3539-2Farooq AV, Shukla D.Herpes simplex epithelial and stromal keratitis: An epidemiologic update.Surv Ophthalmol. 2012;57(5):448-462. doi:10.1016/j.survophthal.2012.01.005Review of Optometry.Be a hero to your HSVK patients.Cleveland Clinic.Ocular herpes (eye herpes).Cedars-Sinai.Herpes eye disease.Weiner G.Demystifying the ocular herpes simplex virus.EyeNet Magazine.Centers For Disease Control.What causes HSV (herpes simplex virus) keratitis.Koganti R, Yadavalli T, Shukla D.Current and emerging therapies for ocular herpes simplex virus type-1 infections.Microorganisms. 2019;7(10):429. doi:10.3390/microorganisms7100429National Health System.Herpes simplex eye infections.World Health Organization.Herpes simplex virus.American Academy of Ophthalmology.Demystifying the ocular herpes simplex virus.Review of Ophthalmology.How to manage ocular herpes.Zhu L, Zhu H.Ocular herpes: the pathophysiology, management and treatment of herpetic eye diseases.Virol Sin. 2014;29(6):327-342. doi:10.1007/s12250-014-3539-2NVISION.Eye herpes: causes, treatment & what not to do.
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Ophthalmology.Herpes simplex virus keratitis: A treatment guideline - 2014.The University of Illinois College of Medicine.Ocular herpes simplex.Zhu L, Zhu H.Ocular herpes: The pathophysiology, management and treatment of herpetic eye diseases.Virologica Sinica. 2014;29(6):327-42. doi:10.1007/s12250-014-3539-2Farooq AV, Shukla D.Herpes simplex epithelial and stromal keratitis: An epidemiologic update.Surv Ophthalmol. 2012;57(5):448-462. doi:10.1016/j.survophthal.2012.01.005Review of Optometry.Be a hero to your HSVK patients.Cleveland Clinic.Ocular herpes (eye herpes).Cedars-Sinai.Herpes eye disease.Weiner G.Demystifying the ocular herpes simplex virus.EyeNet Magazine.Centers For Disease Control.What causes HSV (herpes simplex virus) keratitis.Koganti R, Yadavalli T, Shukla D.Current and emerging therapies for ocular herpes simplex virus type-1 infections.Microorganisms. 2019;7(10):429. doi:10.3390/microorganisms7100429National Health System.Herpes simplex eye infections.World Health Organization.Herpes simplex virus.American Academy of Ophthalmology.Demystifying the ocular herpes simplex virus.Review of Ophthalmology.How to manage ocular herpes.Zhu L, Zhu H.Ocular herpes: the pathophysiology, management and treatment of herpetic eye diseases.Virol Sin. 2014;29(6):327-342. doi:10.1007/s12250-014-3539-2NVISION.Eye herpes: causes, treatment & what not to do.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Academy of Ophthalmology.Herpes simplex virus keratitis: A treatment guideline - 2014.The University of Illinois College of Medicine.Ocular herpes simplex.Zhu L, Zhu H.Ocular herpes: The pathophysiology, management and treatment of herpetic eye diseases.Virologica Sinica. 2014;29(6):327-42. doi:10.1007/s12250-014-3539-2Farooq AV, Shukla D.Herpes simplex epithelial and stromal keratitis: An epidemiologic update.Surv Ophthalmol. 2012;57(5):448-462. doi:10.1016/j.survophthal.2012.01.005Review of Optometry.Be a hero to your HSVK patients.Cleveland Clinic.Ocular herpes (eye herpes).Cedars-Sinai.Herpes eye disease.Weiner G.Demystifying the ocular herpes simplex virus.EyeNet Magazine.Centers For Disease Control.What causes HSV (herpes simplex virus) keratitis.Koganti R, Yadavalli T, Shukla D.Current and emerging therapies for ocular herpes simplex virus type-1 infections.Microorganisms. 2019;7(10):429. doi:10.3390/microorganisms7100429National Health System.Herpes simplex eye infections.World Health Organization.Herpes simplex virus.American Academy of Ophthalmology.Demystifying the ocular herpes simplex virus.Review of Ophthalmology.How to manage ocular herpes.Zhu L, Zhu H.Ocular herpes: the pathophysiology, management and treatment of herpetic eye diseases.Virol Sin. 2014;29(6):327-342. doi:10.1007/s12250-014-3539-2NVISION.Eye herpes: causes, treatment & what not to do.
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