What is ocular herpes and how is it treated?

01/08/2025

Ocular herpes or eye herpes is an infection primarily caused by the herpes simplex virus type 1 (HSV-1). Although this virus is more commonly associated with cold sores, it can also affect various structures of the eye and may compromise vision if not properly treated.

What is ocular herpes?

Ocular herpes occurs when the HSV-1 virus enters the body, usually through the nose or mouth, and remains dormant in the nerves. Under certain circumstances, it can reactivate and affect the eyes. It is a recurrent condition, similar to cold sores, and may reappear in response to certain triggers.

Factors that can trigger an outbreak of ocular herpes

Some common triggers include:

• Exposure to ultraviolet (sun) light
• Hormonal changes
• Episodes of fever or colds
• Eye surgery or trauma
• Physical or emotional stress

How does herpes affect the eye?

Ocular herpes usually affects only one eye, although in some cases both may be involved. It can affect different parts of the eye, such as:

Eyelids: herpetic blepharitis

Inflammation and redness of the eyelids.

Conjunctiva: conjunctivitis

Causes redness and eye irritation.

Cornea: herpetic keratitis

The most common and dangerous form; it can cause scarring that affects vision.

Iris: iridocyclitis

Inflammation of the internal structures of the eye.

Posterior segment of the eye: posterior uveitis

Deeper inflammation that can affect the retina and optic nerve.

Symptoms of ocular herpes

The most common symptoms include:

• Inflammation and redness of the eyelids
• Excessive tearing
• Sensation of a foreign body in the eye
• Photophobia (sensitivity to light)
• Blurred vision
• Mild to moderate eye pain

Diagnosis of herpes in the eyes

Diagnosis is made using various clinical tools.

Clinical assessment

An ophthalmologist examines visible signs of infection and performs a full eye examination.

Additional tests

Although clinical evaluation is usually sufficient to make a diagnosis, in some cases supplementary tests are performed:

• Viral serology to detect antibodies.
• PCR (polymerase chain reaction) – a highly accurate laboratory test to identify the virus in ocular samples.

Treatment of ocular herpes

Treatment depends on the severity and location of the infection.

Antivirals

Certain medications help reduce viral replication.

Anti-inflammatories with corticosteroids

Used carefully under medical prescription to reduce inflammation.

Corneal transplant

In severe cases with corneal scarring that affects vision, a transplant may be necessary to restore transparency.

Can ocular herpes be prevented?

Although the virus cannot be eliminated from the body, the risk of reactivation can be reduced.

Use of UV-protective glasses

Helps protect the eyes from ultraviolet radiation, a known trigger.

Taking care of the immune system

Maintaining a balanced diet, exercising, and getting adequate rest strengthens natural defences.

Regular eye check-ups

Especially if there has already been a previous episode of ocular herpes.

Ocular herpes is a disease that can have serious consequences if not treated promptly. Early detection, appropriate treatment, and prevention of flare-ups are key to protecting visual health. At the first sign of symptoms, consult an ophthalmologist for an accurate diagnosis.

Dr Rubén Delgado, ophthalmologist at the Barraquer Ophthalmology Centre