Eye herpes - you need to know that!

General

The ocular herpes describes an infection of the eye with herpes viruses. Different structures of the eye can be affected (nerves, cornea, etc.). The viruses are either viruses of the herpes simplex group (HSV), which in turn can be divided into type 1 and type 2, or varicella-zoster viruses. These viruses all belong to the herpes viruses, hence the name "ocular herpes".

In addition to ocular herpes, the herpes simplex viruses also often cause herpes simplex keratitis, i.e., herpes-related corneal inflammation. The term "ocular herpes" does not designate a uniform clinical picture, but is to be understood much more as a kind of collective term for diseases of the eye that are caused by herpes viruses.

About 90% of the population become infected with HSV-1 via droplet infection (breathing air) and smear infection in the course of their life and then carries the virus with them for life, stored in the nerve cells. The "herpes" appears symptomatically when the immune system is weakened.

How common is ocular herpes?

Herpes on the eye (herpes corneae) is one of the most common corneal infections in adults.

What are the different forms of ocular herpes?

Depending on the depth of penetration, the following types of herpes corneae can be distinguished:

• Dendritic keratitis: This form of ocular herpes only affects the superficial epithelial layer of the cornea. The sensitivity of the cornea can be limited or completely eliminated.
• Keratitis disciformis: The stroma (middle layer of the cornea between the epithelium and the endothelium) is affected in this form of ocular herpes, but the epithelial layer is intact. Disc-shaped infiltrates can be seen in the stroma.
• Endothelial keratitis / uveitis: If the ocular herpes is severe, viruses are washed into the aqueous humor, which can then lead to swelling of the endothelial layer on the back of the epithelium and thus to glaucoma ("green star").

Recognizing an ocular herpes

How can you recognize ocular herpes?

Since the "ocular herpes" does not represent a uniform clinical picture, it is difficult to recognize it as this. Ophthalmologists often refer to it as a "chameleon" because it can imitate many diseases. However, you can notice changes that indicate an infection and for which you should see an ophthalmologist as soon as possible.

Indications can be blisters on the eyes, redness or other skin abnormalities. Inflammation of the cornea can lead to a foreign body sensation and pain. However, pain does not occur with every inflammation of the cornea. Photophobia and visual impairments are also possible.

With herpes zoster of the eyes, other symptoms are also quite typical. These include sensory disturbances in the area of ​​the bridge of the nose and the tip of the nose as well as the forehead, which are accompanied by severe pain. Other skin areas can also be affected, as is typical with shingles. The skin is extremely painful and shows a decreased feeling of sensitivity, i.e. she feels numb but still shows the greatest pain. Typically, a blister-like, red rash can be seen in the affected skin areas. The skin involvement is localized in a belt shape around the chest and shoulders. Shingles owes its name to this fact. The disease is usually accompanied by a fever and a general weakness.

What are the symptoms of ocular herpes?

With an eye herpes can occur:

• Redness of the eyes,
• Foreign body sensation when blinking,
• severe burning and itching and
• increased secretion of fluid from the eye. up to purulent secretion

Read more on the topic: Pus in the eye

The eyes are often gummy, especially in the morning. Blisters can form on the eyelids that look similar to cold sores. Often the cornea is affected by ocular herpes. Herpes infestation between the wall of the eyeball and the choroid is also less common. This infestation is all the more serious, however, since it affects the area that is necessary for nourishing the retina. Because of this, there is a risk of blindness in this case. The herpes on the eye develops very differently and a medical examination is absolutely necessary.

Symptoms of ocular herpes in brief:

The herpes corneae shows the typical symptoms of corneal inflammation (Keratitis):

• Eye redness
• Foreign body sensation
• Photosensitivity
• Vision deterioration
• (rarely) sticky eyes
• Burning, itching

The more often the relapses occur, the more likely the scarring will impair vision over time, and more and more parts of the eye will be affected with herpes diseases. In severe cases, a corneal ulcer may develop, which when broken open can leave a hole in the cornea. If the condition becomes chronic, it can lead to other eye diseases.

Read more on the subject at: Symptoms of ocular herpes

Treating an eye herpes

How is ocular herpes treated?

After the diagnosis of ocular herpes, the ophthalmologist will prescribe eye drops and / or eye ointments with antiviral agents such as:

• Acyclovir,
• Ganciclovir,
• Trifluorothymidine,
• Trifluridine and idoxuridine.

Read more on the topic:

• Zovirax® eye ointment
• Acyclovir eye ointment

If you have an ocular herpes disease, we strongly advise against self-treatment without visiting a doctor!
The therapy ordered by the ophthalmologist can be supported by avoiding

• direct sunlight,
• Stress and
• Eye strain.

The eye drops or eye ointments with antivirals are dosed in high doses for three days, followed by treatment in the usual dosage for a further ten days. Long-term local antiviral therapy should be avoided as it can damage the epithelial layer of the eye.

What drugs help with ocular herpes?

Under no circumstances should normal eye drops, so-called "whiteners", be used against the reddening of the eyes in the case of herpes, as these agents cause a poorer fluid supply to the eye, which further aggravates the disease.
Hygiene items such as towels and washcloths should not be used in the family under any circumstances, but rather single-use products should be used by the person concerned until the "herpes" has completely healed. A smear infection and thus further spread can only be avoided through strict hygiene.

If the ocular herpes was triggered by another infection (by bacteria), antibiotics can be prescribed to treat the underlying disease. However, the antibiotics are ineffective against the herpes viruses themselves.

Which ointments help with ocular herpes?

There are ointments for treating ocular herpes. They usually contain antiviral substances such as acyclovir or valaciclovir. Herpetic keratitis is treated with such an eye ointment for weeks.

Depending on what type of herpes keratitis it is, topical glucocorticoids can also be applied. However, this is strictly contraindicated for keratitis dendritica, a special form of ocular herpes, since the clinical picture would worsen.

Acyclovir ointments are also used for an ocular herpes caused by zoster viruses. In addition, ointments from a zinc shake mixture can be used for the rash.

Preventing an ocular herpes

What are the causes of ocular herpes?

As already described above, the herpes simplex virus type 1 is able to remain in the body in its inactive form for a lifetime after a single infection, which mostly occurred at a young age. The virus then embeds itself in the nerve cells and usually remains completely unnoticed there - until the disease breaks out again due to the interaction of certain circumstances.

It often happens that a cold or some other illness has weakened our immune system and this is no longer able to keep the herpes virus under control in the nerve cells and the viruses can multiply and spread again.

Hormonal changes can also lead to ocular herpes outbreaks, especially in women.

Most often, however, an increased level of stress is usually an increased stress level, which loads the entire body in an unhealthy way and then of course, in addition to the already exhausting meeting, the upcoming business trip or the big planned wedding day, leads to eye herpes and makes life difficult for us.

For more information read also: Causes of ocular herpes

How can you prevent ocular herpes?

As mentioned earlier, the number one cause of an ocular herpes outbreak is stress. It is therefore important to avoid this if possible.

So it is important to have enough sleep (around eight hours per night), a healthy, balanced diet and a balance to the often stressful everyday life, such as sport or other hobbies.

During an acute outbreak, care must of course be taken to ensure that the viruses are not additionally spread. So it is always important to use your own washcloths and towels, to keep your hands away from the affected area and not to get too close to other people in the area.
The same applies, of course, to an outbreak of cold sores: those affected should always be extremely careful not to wipe their eyes with their fingers after touching the herpes blisters on their lips.

In general, you should avoid scratching the blisters, however annoying they may be. In this way, the risk of developing ocular herpes can be greatly reduced.

To prevent herpes zoster of the eyes, there is also a live vaccine against varicella, which is one of the standard vaccinations for children. The vaccination is carried out as part of the U6 and U7 examinations.

Is ocular herpes contagious?

Infection with herpes simplex viruses usually occurs in young children. The transmission usually takes place by smear or droplet infection and the initial infection is usually symptom-free. However, the virus remains in humans for life and can repeatedly lead to outbreaks of disease if the immune system is weakened.
The initial infection with the varicella-zoster virus also almost always occurs in childhood and then usually leads to chickenpox - a typical childhood disease. This virus also remains in the body for life, but if reactivated it leads to the outbreak of shingles.

In both cases, the virus remains in nerves that supply the infected areas of the body. Accordingly, ocular herpes can occur again and again through direct infection of the eye region, and therefore, in the case of an active herpes infection, care must be taken not to spread it to other parts of the body by scratching or rubbing the infectious vesicles.
When a manifestation breaks out in the eye, one is also contagious for those around him. Therefore, there should be no contact with mucous membranes during the illness. Saliva or other body fluids such as tears should not get into contact with other people. Herpetic rashes should not be touched, as the hands often come into contact with mucous membranes or, for example, the eyes and can thus transmit viruses. Sharing towels should be avoided.

However, if the ocular herpes is recognized in good time, it can be treated well and in any case, the symptoms that arise can be quickly combated, so that consequential damage such as impaired eyesight rarely occurs.

Course of an ocular herpes

What is the duration of ocular herpes?

The term "ocular herpes" does not describe a uniform clinical picture, but is much more a kind of collective term for diseases of the eye that are caused by herpes viruses. The duration of the respective course form or illness can therefore not be determined so precisely. It depends on the exact type of inflammation and the response to therapy.

Herpes keratitis must be treated for at least 2 to 4 weeks, depending on the course and the extent of its severity. However, it is difficult to estimate an exact duration, since the "ocular herpes", as many ophthalmologists confirm, behaves like a chameleon of ophthalmology. The course can be very individual. Recurrences are also possible.

Since a herpes infection of the eye damages the integrity and defense of the cornea, it is more susceptible to microbial infections, which can further prolong the duration of the disease.

Herpes zoster of the eye, also known colloquially as ocular herpes, usually heals after 3 to 4 weeks. However, pain and discomfort can persist beyond that. Then one speaks of a post-therapeutic neuralgia. Therefore, early and good therapy is very important, otherwise the symptoms could become chronic. Recurrences are also possible.

What is the prognosis for an ocular herpes?

The first time the disease appears is often an infection of the superficial layer. This usually heals quickly with appropriate treatment. But since the herpes viruses remain in the organism, the disease can occur again and again.

The following can lead to a new ocular herpes flare-up:

• External irritation,
• Stress and
• Infections

With later herpes attacks on the eye, the deeper corneal layers are always affected, which can lead to dense scarring on the cornea. This can lead to swelling and clouding of the cornea, which can lead to blindness of the affected eye.

How long is the incubation period for ocular herpes?

The incubation time of the various herpes diseases in the eye is very different. The herpes zoster of the eye shows an incubation time of about 7 to 18 days. It is also possible to reactivate an existing infection with herpes zoster viruses. These can remain silent in neural structures for years and reactivate if the immune system is unfavorable, so that the disease breaks out.

The situation is similar with infections caused by herpes simplex viruses of type 1 or 2. A manifestation of the eyes usually occurs after an existing infection with the virus. It is therefore difficult to specify an incubation period.

Further questions about ocular herpes

Can ocular herpes also occur in children?

The ocular herpes can of course also occur in children.

The disease is in no way different from that of adults, only the therapy turns out to be a little more complicated, as cooperation with the little ones is often not yet given and the burning eyes are quickly rubbed with the hands.

Parents must therefore pay particular attention here.

Can ocular herpes also occur in babies?

Herpes viruses can be transmitted to babies during pregnancy or during the birth process, but can also occur after birth. Antiviral medication can be used to prevent transmission from the mother before or during childbirth.

Newborns are often infected with the herpes viruses during normal familial dealings. This transmission takes place through saliva contact or smear infection. A manifestation of an ocular herpes can already show in babies and small children. Similar to adults, it manifests itself in vesicle-like rashes on the eyelids and discomfort in the eyes, such as pain, a foreign body sensation or visual disturbances. Babies can also have a fever.

Particularly in the first 6 weeks of life you should be careful to avoid infection with herpes viruses. If the parents are known to have a herpes infection, they should definitely observe certain hygiene measures. Avoid kissing the baby or sharing cutlery. Also, no shared towels should be used.

If the child has an infection, a quick visit to the doctor is necessary. He can then treat the baby with antiviral medication. This is important because otherwise complications such as an attack on the central nervous system or scarring in the eye are possible.

Read more on this topic at: Herpes in babies - how dangerous is it?

Where can herpes occur?

The activated herpes viruses form the well-known scabby crust on various parts of the body, but often on the lips (herpes labialis). However, the viruses can also attack the eyes and all other parts of the body. In eye herpes (herpes corneae), the eyelids and cornea are often affected. In rare cases, the choroid membrane of the eyes is also affected.

Ocular herpes (Herpes Corneae) is rarely the first site of infection with HSV1 or HSV2, but usually the spread of a recurring (recurrent) cold sore (Herpes labialis).