This is a common infection. It causes keratitis (inflammation and ulceration of the cornea), iritis, and cyclitis. In immunocompromised people it is especially serious.
By skin or mucous membrane contact with a person with HSV.
| HSV-1: orofacial |
| HSV-2: genital |
Both types can cause ocular disease
After initial infection, which often has no symptoms, the virus lies dormant in a large nerve called the trigeminal nerve in the head. Reactivation of the virus may occur months to years later.
This may be triggered by a number of factors shown below. In most cases, however, there is no consistent trigger factor
| Sun exposure |
| "Stress" |
| Trauma |
| Menstruation |
| Surgery eg. corneal graft, laser surgery to eye |
Within one year of primary infection, 10-25% of patients have a recurrence. Those who have had one recurrence are more likely to have further recurrences.
Characteristic skin eruptions, especially around the mouth, lips and eyes. These usually resolve on topical aciclovir [Zovirax] ointment which in the United Kingdom is available without prescription.
| Painful red eye |
| Loss of visual acuity |
| Photophobia (sensitivity to light) |
Less common symptoms are:
| Conjunctivitis (sticky eyes) |
| Blepharitis (inflammation of the eyelids) |
If you have had HSV in the past, and you have these symptoms, you should see an ophthalmologist.
(Do not worry if you do not understand the technical terms)
| Dendritic keratitis (dendritic ulcer) |
| Stromal (disciform) keratitis |
| Non-granulomatous keratic precipitates |
| Iritis |
| Vitritis |
| Retinitis |
| Iris atrophy (uncommon) |
| Trabeculitis |
| Raised intraocular pressure |
The diagnosis is usually made on the history of previous cold sores and the characteristic appearance of the eye (especially where there is a dendritic keratitis). Scrapings of cornea and conjunctiva for viral culture may be useful in cases where the diagnosis is suspect.
| Aciclovir 3% eye ointment 5x/day |
| Steroid eye drops (eg. Prednisolone [PredForte, Predsol], Dexamethasone [Maxidex]) may be used if there is severe iritis |
| Cycloplegics to enlarge the pupil (eg. Cyclopentolate, Atropine) |
| Pressure-lowering drops (numerous) if the pressure is raised |
In very severe cases with permanent corneal scarring, a corneal transplant may be considered to restore vision.