Ocular herpetic disease

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 28, 2016
StartDiseasesOcular herpetic disease

Many of the same herpes viruses responsible for cold sores and chickenpox can also affect the eyes. When they do, the conditions are collectively known as ocular herpetic disease. Unlike herpes simplex type 2, more commonly known as genital herpes, ocular herpetic disease is not sexually transmitted.


Definition & Facts

According to the National Eye Institute, approximately 400,000 Americans have experienced at least one form of ocular herpes. Of those 400,000, half will experience another outbreak within 10 years. There are two viruses that cause the disease: herpes simplex type 1 and varicella zoster virus.

Herpes simplex type 1 is the virus responsible for cold sores. When this virus infects the eye’s cornea, the disease is known as herpes simplex keratitis. Varicella zoster virus, which causes chickenpox and shingles, is known as herpes zoster ophthalmicus when it affects the eye.

Symptoms & Complaints

Because herpes simplex keratitis and herpes zoster ophthalmicus cause redness and pain, they are often misdiagnosed as conjunctivitis, or pink eye, in their early stages. While they share similar symptoms, such as redness, pain, and inflammation, their other symptoms differ. Herpes simplex keratitis may also cause:

Herpes zoster ophthalmicus may also cause:

It’s important to make an appointment with a doctor if experiencing any of the aforementioned symptoms. If left untreated, ocular herpes can cause lingering pain, corneal scarring, loss of vision, and even total blindness.


Ocular herpetic disease occurs when either the herpes simplex type 1 virus or the varicella zoster virus enters the eye. This can occur a couple of different ways. Often, the culprit is a friend or family member experiencing an active herpes outbreak. The virus is present in the saliva and nasal secretions and is transferred to another person through the nose or mouth. The virus then travels to the eye, causing an outbreak.

The other way is for a previously dormant herpes virus to become active. Like many other viruses, herpes viruses are present in most adults. The viruses enter the body, travel to the nerve fibers, and often remain there without ever causing any problems. Occasionally, the viruses will multiply or travel from one location in the body to another, causing a herpes outbreak.

The exact trigger of an outbreak is unknown. However, there are certain emotional and physical stress-related factors that seem to be associated with outbreaks: fever, sunburn, surgical or dental procedures, hormonal fluctuations, excessive alcohol consumption, a weakened immune system, and depression and anxiety.

Diagnosis & Tests

Ocular herpetic disease is diagnosed by a medical doctor, ophthalmologist, or optometrist. The doctor will ask what symptoms are being experienced and will perform a physical examination of the affected area.

If ocular herpes is suspected, further testing will be done to confirm the diagnosis. Methods used to verify the diagnosis include: testing the eye’s pressure level, using dye to check for corneal damage, determining the level of corneal sensation, and DNA testing of the eye fluid.

To test the eye’s pressure level, an instrument called an ocular tonometer blows a puff of air into the eye; elevated eye pressure can mean that something is wrong. Placing drops of a dye called fluorescein into the eye and viewing it under ultraviolet light will reveal any corneal damage. To test the level of corneal sensation, a cotton swab is lightly touched to the eye’s surface. If no sensation is felt, this indicates corneal damage.

In DNA testing, a cotton swab is used to collect eye fluid. That fluid is analyzed under a microscope for the presence of herpes viruses.

Treatment & Therapy

There is no cure for herpes, so the goal of treatment is to lessen the symptoms of an outbreak and reduce the chances of a recurrence. Treatment for herpetic eye disease differs depending on which part of the eye is affected and how severe the infection is.

Mild cases where the cornea has not been affected often require no treatment, clearing up on their own over the course of several weeks. For cases involving mild to severe corneal damage, treatments may include: over-the-counter eye drops for lubrication; prescription steroidal eye drops for treating inflammation; antiviral medications; and, in extreme cases, corneal grafts.

Lubricating eye drops are recommended for patients with previous or current herpes outbreaks, as the affected eye(s) can become dry and irritated. Eye drops containing steroids are beneficial because they treat inflammation and promote faster recovery, especially in cases where the deeper corneal layers have been affected. Antiviral medications can be administered topically, through drops and ointments, or orally in the form of tablets. Oral antivirals can also be used to prevent recurring infections.

Corneal grafts are only required in the most extreme cases where there is severe scarring of the cornea. The procedure involves removing the scar tissue and replacing it with a normal, healthy cornea from a donor. In the case of a corneal graft, patients are often required to remain on steroidal eye drops and/or antiviral medication. 

Prevention & Prophylaxis

Ocular herpes is extremely contagious right before and during an outbreak, and the unaffected eye is particularly vulnerable during this time. That said, there are measures that can be taken to prevent ocular herpetic disease.

Avoiding close contact with anyone experiencing a herpes outbreak is important. If experiencing a herpes outbreak on the face, such as a cold sore, one should avoid touching the affected area. One should make sure to wash one's hands thoroughly if one touches the affected area.

To keep the immune system healthy, eating foods rich in vitamins and antioxidants, getting proper sleep, taking vitamin supplements if necessary, and avoiding or reducing stress as much as possible can help reduce the risk of outbreaks.