Ocular Herpes:A Common Virus Affecting Humans

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Have you ever been surprised to hear that you have Ocular Herpes? Herpes Simplex Virus (HSV) is a common virus affecting humans. It is perhaps best known as the cause of cold sores that sometimes occur following a cold or fever.

HSV has two subtypes:

HSV Type 1: Oropharyngeal pathogen (usually associated with eruptions around the mouth)

HSV Type 2: Genital pathogen

Both types can affect either location

The primary infection of HSV may be asymptomatic in 94-99% of patients. The primary Herpes infection has the following characteristics:

Age

Mean age of onset is 37 years

64% are age 15 or older

<7% are less than 5 years old

Eye features:

Conjunctivitis seen in 84%

Acute conjunctivitis with no corneal or eyelid involvement seen in 7%

Blepharitis seen in 38%

Chronic Blepharoconjunctivitis seen in 15%

Dendritic Keratitis seen in 15%

Stromal Keratitis seen in 2%

HSV establishes latent infection in nerve tissue. This means the infection “sleeps” until some trigger event (such as stress or disease) causes it to reactivate. In the case of Ocular Herpes, the cornea can be the site of latent infection.

Ocular complications from recurrences include:

Blepharoconjunctivitis

Dendritic and Geographic Epithelial Keratitis

Stromal Keratitis

Uveitis

Herpes in the lids can be a primary infection or a recurrence location marked by vesicular eruptions on the lids. The lesions typically ulcerate, and then heal without scarring unless a secondary infection occurs.

Because of its proximity to the eye, this Blepharitis can lead to Keratitis. Ocular Herpes typically affects one eye.

Herpes in the cornea is seen more commonly in its superficial layer, the epithelium, and is often characterized by a dendritic (looking like a tree) ulcer.

Besides assessing the clinical signs and symptoms, your eye doctor may get a viral culture from your eye and use various lab tests to detect HSV antigen.

The treatment will include both topical (eye drops) and oral antiviral agents. The oral agent is given to reduce the likelihood of recurrence.

You may also get topical antibiotics in order to prevent a secondary infection. Ocular lubricants may also be used to sooth the eye.

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