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Ocular Herpes

Also known as herpes simplex keratitis, eye herpes, HSV keratitis

A herpes infection of the cornea that tends to recur — and scars sight if it is treated as ordinary pink eye.

About 1 minute to read

Overview

Herpes simplex, the virus behind cold sores, infects most people early in life and then lies dormant in the trigeminal nerve. When it reactivates down the branch that supplies the eye, it produces a branching ulcer on the cornea called a dendritic ulcer.

It is the single most common infectious cause of corneal blindness in developed countries, and the reason is repetition rather than severity: each recurrence can leave a little scar, and scars in the visual axis add up. Shingles of the eye — herpes zoster ophthalmicus — is a related but distinct problem from the chickenpox virus.

What are the common symptoms?

  • A red, painful, watering eye, almost always one side
  • Strong light sensitivity
  • A gritty foreign-body feeling
  • Blurred vision if the ulcer sits over the pupil
  • Cold sores on the lid, or a rash on one side of the forehead and nose

What causes it, and who is at risk?

Reactivation of latent herpes simplex virus. Triggers include illness and fever, strong sunlight, physical or emotional stress, injury or eye surgery, and anything suppressing the immune system, including steroid drops given for the wrong diagnosis.

Recurrence is common — roughly a quarter of people have another episode within two years, and the risk rises with each one.

How is it treated?

Antiviral treatment, as drops or ganciclovir gel plus oral aciclovir or valaciclovir, started early. A dendritic ulcer usually heals within one to two weeks on treatment.

Steroid drops without antiviral cover can turn a superficial ulcer into a deep, sight-threatening one, which is why self-treating a red eye with leftover drops is a bad idea here. People with repeated episodes are often kept on long-term low-dose oral antivirals, which cuts recurrence substantially. Established scarring may eventually need a corneal transplant.

When to get seen quickly

A painful red eye with light sensitivity, especially with a cold sore or a one-sided rash on the forehead or the tip of the nose, needs to be seen the same day. Do not use any steroid-containing drop until a doctor has looked at the cornea.

This page is general information, not a diagnosis. Only an eye care professional who has examined you can tell you what is actually going on.

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Related conditions

Conjunctivitis Inflammation of the clear membrane over the white of the eye — viral, bacterial or allergic, and treated quite differently in each case. Eye Infections Everything from mild pink eye to a sight-threatening corneal ulcer — pain and vision are what separate them. Uveitis Inflammation inside the eye — painful, light-sensitive, and needing prompt treatment to protect vision. Corneal Abrasion A scratch on the surface of the eye — intensely painful, usually heals within days, and needs checking.
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