Herpes simplex eye infection
This is inflammation of the eye caused by the herpes simplex virus, the same one behind cold sores on the lip.
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Medicines commonly prescribed for Herpes simplex eye infection
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 800 mgActive substance: aciclovirManufacturer: Towa Pharmaceutical S.A.Prescription requiredDosage form: TABLET, 800mgActive substance: aciclovirManufacturer: Laboratorio Stada S.L.Prescription requiredDosage form: TABLET, 200 mgActive substance: aciclovirManufacturer: Glaxosmithkline S.A.Prescription required
This is inflammation of the eye caused by the herpes simplex virus, the same one behind cold sores on the lip. The eye turns red, hurts, waters and copes badly with light, and nearly always only one eye is involved. An episode settles within a couple of weeks, but the condition has a habit of coming back, and every return leaves a mark on the cornea. That is why herpes of the eye remains, worldwide, one of the leading infectious causes of lost sight. Two conclusions follow, and they are worth holding on to ahead of everything else here: see a doctor quickly, and never put steroid drops into such an eye on your own initiative.
What it looks like
It usually starts with the feeling that something has got under the eyelid. Then come:
- pain or a raw, gritty ache in one eye;
- redness, most marked in a ring around the iris;
- heavy watering;
- an intolerance of light that makes reading and screens hard work;
- blurring and haloes around street lamps;
- a swollen, reddened eyelid;
- sometimes small blisters on the lid or on the skin around the eye.
The virus can attack different layers. Most often the surface layer of the cornea suffers: a distinctive branching ulcer forms there, which the doctor sees once it is stained. That is the most favourable version and it heals faster than the rest. Deeper lies the stroma of the cornea, where inflammation lasts longer and is driven less by the virus itself than by the eye's own immune reaction; that is the form that leaves scarring and takes vision away. Less often the inflammation moves inside the eye, to the iris and the uvea, and very rarely it reaches the retina.
There is an important detail few people know: with repeated episodes the eye hurts less. That is not a sign of recovery. The virus damages the nerve endings of the cornea, which loses sensation, so the protection disappears along with the pain: it is precisely the "quiet", numb eye that heals worse and progresses to a deep ulcer more easily. Less pain in a recurrence is a reason to be seen sooner, not later.
Where the virus comes from and why it wakes
Most people acquire herpes simplex, usually in childhood, through everyday contact: skin, a kiss, shared crockery. The first encounter often passes unnoticed. After it the virus does not go away: it settles in a nerve ganglion at the base of the skull, from which the nerves to the face and eye set out, and stays there for life in a dormant state. A flare-up is not a fresh infection but the waking of your own virus, which travels down the nerve fibre to the cornea.
It can be woken by fever and any other illness, by heavy stress and lack of sleep, by strong sun and light reflected off snow or water, by an injury to the eye or surgery on it, and by weakened defences — from chemotherapy, from drugs that suppress immunity, from some chronic diseases. In some women flare-ups track the menstrual cycle.
Catching eye herpes from someone else's eye is all but impossible, and nobody needs to be isolated. Even so, wash your hands more often than usual, do not rub the eye and do not share a towel or eye make-up. One separate rule: anyone with an active cold sore should not kiss a newborn, because in the first weeks of life herpes is dangerous, and a red watering eye in such a baby along with blisters on the skin needs to be looked at without delay.
How urgently a doctor is needed
A red eye that hurts always warrants being seen the same day rather than watched for a week. Do not put off the appointment if:
- the eye genuinely hurts rather than merely stinging;
- looking at light is uncomfortable or painful;
- vision has worsened, blurred, or haloes have appeared;
- blisters have come up around the eye or on the lid;
- you wear contact lenses and the eye has turned red;
- something like this has happened before and is happening again.
There are also signs that need attention within the hour: severe eye pain with nausea and vomiting, an eye that has gone very dark red and feels hard, pupils of clearly different sizes, a sudden drop in vision, something that has entered or pierced the eye, or a chemical burn. With a chemical burn you do not start by phoning but by rinsing: clean water, plenty of it, for at least twenty minutes, and only then set off. If there is no eye service nearby and the situation is severe, call an ambulance — across Europe the number is 112 — and do not drive in that state. Take with you the list of medicines and eye drops you use.
What not to do before you are examined
There are several prohibitions here, and the first matters more than anything else on this page.
- Do not use steroid eye drops. They are often left over at home from an earlier prescription and reached for "to take the inflammation down". On a herpetic corneal ulcer, a steroid without antiviral cover removes the immune response that has been containing the virus, and a small surface ulcer becomes a wide, deep one within days, up to perforation of the cornea. Steroids are used in treating the deep forms, but only an ophthalmologist starts and stops them.
- Take contact lenses out and leave them out until the doctor says otherwise. The lenses and solution used during the flare-up are replaced with new ones and the case is thrown away.
- Do not put cold sore cream on the eye. Preparations for the skin are not designed for the cornea and irritate it; eye formulations of antiviral drugs exist separately.
- Do not use antibiotic drops "just in case". They do nothing against a virus, and time for the right treatment is lost.
- Do not cover the eye with a tight pad and do not apply heat to it.
- Do not rub the eye and do not use anyone else's drops.
How it is diagnosed and treated
The diagnosis is made by an ophthalmologist at the slit lamp. A dye is put in and the damaged area of cornea takes it up: the branching ulcer, shaped like a small twig, is so characteristic that it is usually enough on its own. The doctor also tests corneal sensation and examines the inside of the eye to establish how deep the process goes. Laboratory confirmation from a swab is needed only occasionally, in unclear cases and severe ones.
Treatment is built around antiviral drugs. For the surface form an eye ointment or drops are prescribed, sometimes tablets; a surface ulcer usually heals in one to three weeks. Sometimes the doctor gently lifts off the damaged epithelium, which speeds healing. In the deep form steroid drops are added to the antiviral to settle the immune inflammation, and the rule here is strict: the steroid only alongside an antiviral and only to the doctor's schedule, with a gradual reduction. Stopping the drops as soon as things ease is the commonest reason it comes back.
Recurrences happen in roughly half of those affected. If they are frequent, a long course of antiviral tablets at a maintenance dose is discussed, which noticeably reduces the number of relapses. Removing the triggers helps too: sunglasses in bright light, a sensible sleep pattern, treatment of anything that weakens the defences. If several episodes leave a permanent haze on the cornea and vision falls, a corneal transplant is considered; it is done on a quiet eye and under antiviral cover, because the virus has not gone anywhere.
What can look the same
A red, painful eye is a sign shared by several conditions, and a patient cannot tell them apart by looking. It helps to know what else the doctor is weighing up.
- Shingles around the eye. A different virus causes it, the one behind chickenpox. The rash runs in a band across one side of the forehead, and blisters on the tip and side of the nose are particularly worrying: they indicate that the nerve branch running to the eye is involved. Antiviral tablets need to be started here as early as possible.
- A bacterial or amoebic corneal ulcer in a contact lens wearer. The amoebic one is especially treacherous: the pain is far worse than the appearance would suggest, and it is usually linked to rinsing lenses in tap water or wearing them in a swimming pool. Delay here costs sight.
- Adenoviral conjunctivitis: highly contagious, with copious watery discharge and a swollen gland in front of the ear, and it usually spreads to the second eye.
- An acute attack of closed-angle glaucoma: severe pain, coloured haloes around lights, nausea, an eye that feels hard. This is an emergency.
- Inflammation of the iris, a foreign body, a corneal scratch, or a flash burn from welding without a shield.
Online consultation
On this subject a remote appointment is valuable above all for the speed with which it sorts out priorities. The doctor will ask about the character of the pain, about light sensitivity and about vision, will ask to see the eye and the lid on camera, will check whether you have had cold sores and whether you wear lenses, and will say the essential thing: whether an examination at the slit lamp is needed today, whether it can wait until tomorrow, or whether this looks more like something else. The same appointment covers recurrences: whether to move to maintenance tablets, how long to keep using what was prescribed, what to do about lingering light sensitivity and dryness, and how to prepare for planned eye surgery if there is herpes in your history. The signs on the urgent list are not dealt with through a screen — with those you go straight in.
This material is for information only and does not replace medical advice.
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