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Herpes and the Eye

There are two types of the basic  Herpes Simplex Virus, or HSV:

•    Type 1 – this is the one that produces cold sores or blistering on the lips and is thought to be contracted at an early age from kissing on the mouth by family members who have the dormant virus.

In a funny way it’s good that the eye version of herpes comes from this Type 1 Herpes as symptoms and treatments are easy to deal with.

•    Type 2 – this is the one that affect the genital area and although eye infection can be contracted from it, as in the case of mothers passing it on through the eyes to her baby whilst giving birth, instances are relatively rare.

So what is Herpes?

The jury is out on what Herpes really is, but most people are exposed to the virus in early years and either contract it or not – and if they do contract it the virus lays dormant ready to spring into life again.

The cold sore blisters associated with the herpes seem to come out of nowhere on the oddest occasion, although they do often accompany winter colds.

It’s not considered worthwhile visiting the doctor for such a minor ailment, but dentists see quite a few cases of course in their line of work, and they offer an effective preventative remedy:-

“At the very earliest onset of the very slightest tingly feeling, which is the first sign of a cold sore, as soon as you can – meaning as soon as you can! – hold an ice cube on it for as long as you can stand the pain”

People who have used this remedy say it really works.

Another more proven treatment is to use Zovirax ointment (Acyclovir).  This is available in ointment form over the counter for cold sores and is the main line of treatment for epithelial herpetic keratitis of the eye.  The eye ointment requires a prescription by a therapeutically qualified optometrist or ophthalmologist.

Occasionally herpes cold sores are recurrent. In this case preventative oral Acyclovir has been shown to reduce recurrence.

Ocular (Eye) Herpes

Of the millions of people who get herpes cold sores every year only about 2% will go on to get an eye herpes infection, and whilst with a cold sore it’s just a case of waiting it out, with the eye version it’s best to consult an eye-care professional such as an optometrist.

There are several variations of eye herpes that need anything from mild attention to serious treatment to prevent serious vision loss:

•    Epithelial Keratitis – this is the commonest form of eye herpes and affects the top layer of the cornea. A course of eye drops is usually sufficient to clear it up.

•    Stromal Keratitis – affects the deeper part of the cornea and so steroid eye drops are often prescribed, but only under strict supervision of a therapeutically qualified optometrist to ensure there will be no loss of vision.

•    Herpetic Uveitis – a particular type of uveitis caused by herpes and sometimes present with keratitis. Uveitis is an inflammation of the inside of the eye called the uvea.

•    Herpetic Retinitis – in this case the herpes virus infects the rear of the eye in the retina.

Symptoms

Symptoms include those exhibited in many diseases and disorders of the eye and it takes an experienced eye-care professional to detect the condition:

•    Sensitivity to light

•    Bumps on the eyelid

•    Pain in or around the eyes

•    Red or “pink” eye, typically seen with conjunctivitis

•    Vision becoming gradually blurred

Causes and Prevention

Knowing the causes of Eye Herpes can help in those contracting the condition from having too many recurrences:

  • Mainly due to contact with another person with the condition
  • Too much sun
  • Stress!
  • Too much rubbing of  the eyes
  • Eye strain, particularly from over use of computers – this one is controversial.

Sometimes Eye Herpes becomes recurrent and the only way to try and reduce recurrences is with the use of oral Acyclovir.  It is a relatively benign drug with few side effects.  This is best prescribed by a corneal specialist, as recurrent herpes in the eye can lead to blindness if not treated promptly.

About the Author

Dr Jim Kokkinakis (Optometrist) graduated in 1983 from the Optometry School University of NSW. He is currently a Senior Lecturer there and regular speaker to both Optometrists and Ophthalmologists in Australia and Internationally. He has a specialist clinical practice in the Sydney CBD with interests in Eye Strain, Computer Vision problems, Treatment of Eye Diseases and complex Contact lens Fittings.

Comments (50)

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  1. zak parsonage says:

    hi ive just read this article and would like to ask a few questions.
    i contracted the herpes virus in my right eye when i was approximatley 6 months old i have regular reacurrences and flare ups i have been going to my local royal eye infermary since i was about 6 months old aswell i am now 24.
    my vison in my right eye has gradually got worse and more blurred in the last 3-4 years and im not sure if my eye infermary are doing enough to help as i keep getting the same treatments and answers and it doesnt seem to be getting any beter i think i have less then 30% vision now and its effecting my judging of distance it really effects my day to day work and could also be quite dangerous. i am worried that eventually i will go blind completley, i was wondering if there is any sort of treatment to help with the blurred vison or operations i am willing to try absolute anything!!i was an aspiring and a very good boxer but couldnt continue with it due to my condition please could you contact me with any information or details thank you very much for taking the time to read my email

    regards zak parsonage

    • Jim (http://www NULL.optometrist NULL.com NULL.au) says:

      Hi Zak
      Where are you from? Recognized treatment for recurrent herpetic disease is taking oral (in tablet form) Acyclovir or Famvir (they are similar drugs). These must be taken for ever. As far as surgery is concerned your only possibility is a corneal transplant. This type of procedure is often not successful due to recurrence of the herpes. A contact sport after a corneal transplant is not possible due to the possibility of rupturing your eye from a punch or a finger in the eye eg. wrestling.

  2. Kendra says:

    I was just wondering how long this takes to go away and will I have this come up all the time for the rest of my life.

    • Jim (http://www NULL.optometrist NULL.com NULL.au) says:

      Hi Kendra. Herpetic infection in the eye can keep coming back, but is very individual. The key is to make sure you have a good optometrist that is therapeutically qualified to monitor you. Any sign of flare up needs managing immediately. Often taking oral anti virals like Famvir is prescribed to keep things quiet.

  3. Nic says:

    Hi, my 2 year old daughter has contracted mouth herpes and i noticed a couple days ago her eyes were red and sore looking and she was complaining about bright light. They weren’t particularly watery and there was no puss like usually seen in conjunctivitis. Just wondering if it is worth getting her checked with such subtle symptoms?

    • admin says:

      Hi Nic
      Herpetic infection as a baby occurs to the majority of the population. It is possible that the infection has spread into the eyes. It is a good idea to see a therapeutic optometrist that can prescribe ophthalmic acyclovir ointment.
      Regards
      Dr Jim Kokkinakis

    • Eva says:

      How did your daughter contract mouth herpes?

  4. samantha marshall says:

    Hi my 6 year old daughter has sufferd with this virus in her eyes since she was 3 she as been given Acyclovir oral medicine wich she takes twice daily 7am 7pm they have givin her glasses and an eye patch she as scaring in central of her cornea she is under a consultant at the uhns hospital but for the the past 8 days her eye as been bright red and sore to touch i dont no if to call hospital or what to do as i dnt want to waste there tie if its nothing ttanks samantha

    • admin says:

      Dear samantha
      i am sorry for the late reply. I was away for most of may and was not able to answer questions on my websites.
      By now you will have done something about this, but any time this happens it is important to seek a consultation immediately as more than likely there is a flare up and without aggressive treatment further scarring will occur.
      Regards
      Jim

  5. raika says:

    hi,
    i want to know is there any way to get back the sight of a blind person with ocular herpes?
    my friend is 34 yeras old, he was child got ocular herpes and one of his eyes got wors by the years now one of his eyes is blind and another one has a bad sight. drs say if we treat it might be blind both of them is it true? what should we do?

    • admin says:

      Ocular herpes can have devastating effects but usually only in one eye. each case is unique to the individual so without seeing your friend it is impossible to know what can and cannot be done. Any surgery on an eye with ocular herpes is usually unsuccessful in the long term. There is a small (very small) possibility that both eyes could become blind but I think the main issue is that surgery is rarely successful to the operated eye. The next question becomes what is the diagnosis of the other eye? Is it ocular herpes or is it something else (which is usually the case).
      Regards
      Dr Jim Kokkinakis

  6. Valerie says:

    Hello,Dr Jim,can you please tell me what else i can do for eye herpes.Virgan gel 5 x daily,also the best Dr to help.
    Regards from Greece.

    • Jim (http://www NULL.optometrist NULL.com NULL.au) says:

      Hi Valerie
      You can also use acyclovir oral tablets. You need to see a corneal surgeon. Greece has many well trained ophthalmolgists, but make sure they are corneal trained.
      More on herpes eye disease can be found on my blog: (http://www NULL.theeyepractice NULL.com NULL.au/optometrist-sydney)

  7. Christina says:

    Hi..
    I have extreme blurriness I’m my eye and my optometrist said I have herpes symplex and it has not went away I’m taking erythromycin ointment and aryclovior pills that the er prescribe me I’m very scared because I don’t want to go blind. .. is there a possibility that this will clear up I’m 21 weeks pregnant

    • Jim (http://www NULL.optometrist NULL.com NULL.au) says:

      Hi Christina of course there is a possibility this will clear, but I would recommend a second opinion. Where are you located?

  8. Jackie says:

    Thanks for the informative article. I have detailed my questions in your contact us section and hope to hear a reply soon. My child has had HSV around his eye multiple times and as it may affect vision am very concerned and would love more information regarding ocular herpes in children. Thanks

    • Jim (http://www NULL.optometrist NULL.com NULL.au) says:

      Dear Jackie
      Thank you for contacting us. I hope we have been able to direct you into a better space for this very scary condition. Especially when it comes to our children.

    • Anne says:

      My son is 11 and has that around eye as well. Maybe we could connect with each other?

  9. Gina says:

    Hi, I’ve had herpes 1 for many years and typically have flare ups on my mouth when I am run down or stressed.

    I have recently had flu and I am sure not helped by running my eyes, I have developed herpes on one eyelid. From what I have read above it doesn’t seem like ocular herpes as it doesn’t effect my eye at all. It is the outdid lid that is sore and bumpy and about to blister.

    I’d like to apply acyclovir to the skin on my eyelid and of course avoid my eye, but am concerned if the acyclovir itself could be harmful if absorbed around my eyelid, or if having heroes on my eyelid is more serious and can effect my eye?

    • admin says:

      Gina you can apply acyclovir ointment to the eye lids and even in the eye. It is best to get the ophthalmic quality version which is more pure than the one that is used on the lips.

  10. Lee says:

    Hello, I have just been diagnosed with a case of this and I am taking oral acyclovir and drops, but the swelling in my eye is getting worse and the drops I put in seem to not be absorbed and are running out the sides of my eye. I also keep getting very sharp pains in my infected eye as well. Is all of this normal?

    • Jim (http://www NULL.optometrist NULL.com NULL.au) says:

      Depending on how long you have been taking the medication. I would suspect if it is not getting better after a week, you need another consultation by a corneal specialist.

    • Myrtha Reyes says:

      Hi!
      I have this problems for more than 30 years, The ointment works, but before it gets better, it feels like is getting worse, is a typical pattern of recovery.
      Some times Doctor gives me steroid drops to ascelerate the recovery.
      I hope this help you

  11. Debbie says:

    Hi, my husband was prescribed numbing drops by an ER DR. Those drops burned his cornea. Now he has contracted herpes on top of that. His eye looks like hamburger meat. The cornea is all “chewed” up. This began on the 8th, it is now the 24th. He is still in nonstop excruciating pain. Migraines. He can’t do anything but sit in a recliner…..he is so light sensitive he can’t go outside. He is wearing 2 pair of sunglasses. He is being seen by a cornea specialist. There has been zero improvement. The Dr. Says it could be weeks of pain like this. Should we seek a second opinion…..oh I forgot to mention, he has nearly zero vision in that eye as well. He can only see a shadow of a hand moving just inches from his face. That happened after 2 days of using the numbing drops as needed for pain, per the ER DR.

    • admin says:

      Debbie
      This is horrific. An ER doctor is under a lot of pressure to make decisions quickly. In hind sight it would have been better to see an optometrist or an ophthalmologist. I would definitely get a second opinion. More than two weeks in such a state, might need a differnet approach.

  12. Letitia says:

    Hi, just recently, my right eyelid has become swollen and very sore. The lid has also developed a small group of bumps. It started out as only being sore, with a stinging sensation but gradually worsened over the last couple of days.

    I have had a similar situation with the same eyelid two years ago but there were two tiny dots that looked to almost look like spider bites. Could I possibly have eye herpes or could this be a flare up from the previous occasion?

  13. Haydon says:

    I recently had cataract surgery on both eyes results were good to stsrt with for a few weeks now the are very sore could i have eye herpes as i suffer from genital herpes

  14. Bo says:

    Hi there,
    I have recently contracted oral herpes with some scarring on the cornea. I have been an avid surfer all my life and it is also my livelihood. I have used contact lenses most of my life and really can not surf without them. Will I be able to wear contacts again and how progressive is the disease please. Thankyou

    • admin says:

      Hi Beau
      Unfortunately surfing and being in the sun is a risk factor for reactivation of both oral and corneal herpes. Of course everyone is unique so I can only make generalisations. If you are prepared to take the risk and insist on continuing your surfing, then I would recommend the following:
      1. Wear scleral contact lenses. These are custom made and are expensive, but they will protect your eyes the most.
      2. Maybe even go to the rouble of wearing surfing goggles with a tint in them.

  15. Wendy Oglesby says:

    I have had keratitis of the eye since I was 6 mo old I am now 40 yes old’ daily I take 500 mg of Valtrex as a maintenance med & if have a flare they up that to 1 gram a day’ 8 also take Predinisole suspension drops when my eye is irritated whenever I choose’ and if I have a full on corneal blister then I take the 1 gram of Valtrex the suspension drops & acyclovir (opthamalic) as well’ I have had multiple surgeries as a child in the 70’s on this EYE & the vision is blurred only color distinctions nothing else’ & it’s been that way my entire life’ maintenance meds help tremendously daily! Non-stop!

    • admin says:

      Thanks for your feedback Wendy. Herpetic keratitis usually on affects one eye luckily. Oral antivirals like Valtrex are extremely beneficial in the long term to inhibit flare ups.

  16. Tammie says:

    I always get a herpetic breakout after Christmas. This time I could feel it in my left eye. I only have the Zovriax cream (prescription) My skin looks alot better but my eye is hurting. I went to a weekend clinic who absolutely did zero for me! I explained to this newbie nurse practitioner that I needed the oral pill form now until I could see my doctor or a specialist. I told her to check my chart on what my doctor has done in past. She refused! It’s New Year’s eve folks. She said NO to acylovir pills and for me to go to E/R. I told her NO mainly because they will not have a OPthalmologist E/R doctor especially on New Year’s. She felt more than comfortable to just let me go untreated knowing this. I just read above story on man going blind over numbing drops in E/R. NO THANKS! I’ll just use my cream, take 500mg of Lysine 3 times a day until I can call my doctor on Monday. What a LOSER she was!

    • admin says:

      Tammie what’s sad about this is that there is little harm in giving someone with a previous history of herpetic eye disease. A nurse practitioner is given a lot of responsibility. They will get no recognition for doing something right, but will get crucified if something goes wrong. They therefore are very defensive in how they prescribe. The other issue is that their knowledge of eye disease is very very limited.

  17. Shawn says:

    Is it possible just to get HSV on the eyelid and not in the eye itself.i just found out my daughter has it and I am so scared.They gave me the valtrex oral to clear up her skin and it’s doing a good job I am just worried.

  18. Louis says:

    My 6 year old got a cold soar, which started spreading. Now his eyes are red, and swollen . Do you think he spreaded the virus to his eyes?

  19. Pamela says:

    My mom is going blind from her pies in her eyes. Doctors have tried everything and the sad part is all of them pass her onto more doctors that just take her money and promise her hope when they are just to chicken to admit to her it’s useless…. there is n hope… there is no cure… and she is blind…

  20. Pamela says:

    One comment I read just now said she takes LYSINE….. my mom has weak kidneys so should we stay away from this vitamin? I am desperate to try anything for mom!
    Anyone care to comment on this vitamin …. is it helping ?

    • admin says:

      Pamela
      Lysine apparently does help herpectic keratitis but I am not a nephrologist (kidney specialist). I would take this matter up with her doctor.

  21. Nell says:

    Hi I have genital herpes, I was taking a shower and when I was hanging my washcloth up over the shower some of the water from the towel acciendently got in my daughter’s eye when she was standing by the tub. should I be worry?

  22. Adelia says:

    I am scheduled for cataract surgery in both eyes in about a month but forgot to mention that in my twenties – i am 62 now, I contracted herpes 2. Could this thinf in my eyes be that and not cataracts? One of the problems i have is that if light isin my face I cannot see.

    • admin says:

      Adelia this is hard to answer without seeing you. This is because when light is in your face both a scarred cornea from herpes or a cataract can cause the symptoms that you mention. If you cornea is not scarred then it will be cataract casing this problem.

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