Patient information from BMJ

Herpes simplex eye infection

Last published:Aug 03, 2021

If you've got herpes simplex eye infection it means your eye is infected with the herpes simplex virus. The infection will probably go away in a couple of weeks. But there's a chance it could cause more serious problems that might damage your eyesight.

You can use our information to talk to your doctor and decide which treatments are best for you.

What is herpes simplex eye infection?

Many people carry the herpes simplex virus in their body. Usually it doesn't cause problems. But if the virus infects your eye it can make it red and uncomfortable. It can cause sight problems, but this is rare.

In most people herpes eye infection is caused by herpes simplex type 1. This is the virus that causes cold sores on your lips. But it can be caused by herpes simplex type 2. This virus usually causes genital herpes.

Herpes eye infection usually affects the front part of the eye, called the cornea. The cornea is clear and less than 1 millimetre thick. It protects the rest of the eye.

Usually the infection affects the top layer of the cornea (the epithelium). The infection can damage the tissue and cause an ulcer. Sometimes the infection affects the middle layer of the cornea (the stroma). This is more serious.

In some people the infection affects only the eyelid or the outside of the eye (the conjunctiva).

What are the symptoms?

You might not get any symptoms, especially the first time you have herpes simplex eye infection. But it's important to go to the doctor if you do have symptoms. These can include:

• a swollen eyelid

• redness, pain, or discomfort in the eye

• pain when looking into bright light

• watering eyes

• blurred eyesight.

If your doctor thinks that your symptoms are caused by herpes infection he or she will probably refer you to a specialist eye doctor, called an ophthalmologist.

What treatments work?

The treatment you need will depend on which part of your cornea is affected. If you have contact lenses you should not wear them until your eye has healed.

Medicines

To help with pain your doctor might recommend taking paracetamol, ibuprofen, or another type of pain reliever. Your doctor might also prescribe eye drops to help with other symptoms, such as pain when looking into bright light.

If your infection affects the top layer of the cornea (the epithelium), antiviral eye ointment should help your eye to heal.

Most people with herpes eye infection of the top layer of their cornea get better in a couple of weeks, even without treatment. But your doctor will probably suggest you have treatment to help your eye heal faster. Treatment can also stop the infection spreading.

When you use antiviral eye ointment your eyes might water more than usual or feel itchy and uncomfortable.

Some doctors wipe away the infected tissue from the cornea before starting treatment with eye ointment. This is called debridement.

If you have an infection of the middle layer of the cornea (the stroma) antiviral tablets plus steroid eye drops work best to heal the eye.

The full name for these steroids is corticosteroids. They are similar to chemicals your body makes naturally to fight inflammation (swelling). They are not the same as the anabolic steroids used by some athletes and bodybuilders.

A side effect of steroid drops is that they can make the herpes virus infection more likely to spread to the top layer of the cornea (the epithelium). So you might get an ulcer there. You'll need to get your eye checked regularly while you're using these eye drops.

Treatment to stop the infection coming back

If you get repeated infections you’re more likely to get damage to your eyesight. So you might want to try treatments to stop the infection returning.

Taking antiviral tablets daily can help stop you getting another herpes eye infection. These tablets can't get rid of the virus altogether, but they might stop repeated flare-ups of the infection.

What will happen to me?

Your infection will probably go away in a couple of weeks. But there's a small chance it could scar your cornea, which can damage your eyesight. This is more likely if you get repeated infections.

If your cornea has scarring that is affecting your vision, treatment can help. If the scarring is mild you might be offered laser surgery.

If the scarring is more extensive you might need to have a corneal graft operation. This involves cutting away the damaged part of your cornea and replacing it with a piece of cornea from a donated eye. Your doctor will help you explore your options.