Herpetic Eye Disease

What is herpetic eye disease?

There is a family of viruses that are all called herpes virus. Two of these viruses can cause infections in the eye, which is called herpetic eye disease. These two viruses are not the same virus that causes genital herpes, and herpetic eye disease is not a sexually transmitted disease.

One virus that causes herpetic eye disease is called the varicella-zoster virus. It is the same virus that causes chickenpox and also the nervous-system disease known as "shingles." When this virus affects the eye, it is called herpes zoster ophthalmicus.

The other virus that causes herpetic eye disease is called herpes simplex type 1. Herpes simplex type 1 is the same virus that causes cold sores on the lips and mouth. In the eye, it usually causes an infection of the cornea. This infection is called herpes simplex keratitis.

Although both of these problems are caused by a herpes virus, they are different types of infections that might need different types of treatment.

How does herpetic eye disease develop?

Like many viruses, the herpes simplex 1 and varicella-zoster viruses are actually present in most adults. The viruses in the herpes family usually live around the nerve fibers in humans without ever causing a problem. Occasionally, the viruses will start to multiply, or they will move from one area of the body to another, and that is when herpetic disease breaks out. This often happens when the immune system of the body is weakened by some other health problem.

How is herpetic eye disease diagnosed?

The two different types of herpetic eye disease have different symptoms. One thing they have in common, however, is that they can both be very painful because they affect the nerves directly.

The problem is likely to be herpes zoster ophthalmicus if your doctor finds some or all of these symptoms:

• Pain in and around only one eye
• Redness, rash, or sores on the eyelids and around the eyes, especially on the forehead (Sometimes the rash breaks out on the tip of the nose.)
• Redness of the eye
• Swelling and cloudiness of the cornea

The problem is likely to be herpes simplex keratitis if your doctor sees these symptoms:

• Pain in and around only one eye
• Redness of the eye
• Decreased vision
• Feeling of dirt or "grit" in the eye
• Overflowing tears
• Pain when looking at bright light
• Swelling or cloudiness of the cornea

Your doctor might want to use special tests if it looks like herpetic eye disease might be present. The pressure inside the eye will probably be checked, for example. There is also a special dye called fluorescein that the doctor might put into the eye. This dye glows under ultraviolet light and will show the doctor if the virus is causing problems on the surface of the eye.

How is herpes zoster ophthalmicus treated?

Because herpes is a virus, antibiotics such as penicillin are not an effective treatment. The only drugs that will work against herpes infections are antiviral medications.

Depending on how serious the herpes zoster ophthalmicus is and what part of the eye is affected, your doctor will recommend antiviral eye drops, pills, or both. No matter what kind of medicine is recommended, it is important to keep using the medicine for as long as your doctor recommends. Even though the eye might start to look or feel better, the infection could come back if you stop taking your medicine too soon.

If the infection is affecting the cornea, another kind of eye drops called corticosteroids might also be recommended. Corticosteroids will help control the disease, but they can also raise the pressure in the eyes of some people. If corticosteroids are being used, it is important for the patient to come back to the doctor's office so the pressure can be checked.

Another type of eye drop might also be prescribed to keep the pupil dilated. This will help the eye's natural fluids flow, which prevents the pressure from increasing.

Unfortunately, herpetic eye disease can be painful even after several days of treatment when the eye is starting to look better. This can be discouraging, but it does not mean that the treatment is a failure. The medicines are working, and the pain will go away eventually.

How is herpes simplex keratitis treated?

The same types of eye drops and pills are prescribed to treat herpes simplex keratitis. It is also just as important to use the medicines as recommended, and to keep all appointments with your doctor.

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