If your doctor suspects a herpes eye infection you will be referred urgently to an eye specialist. A specialist will do a detailed magnified examination of the eye. This is to confirm the diagnosis and to determine if the infection is in the top layer of the cornea or if the deeper layers are involved (stromal keratitis).
What is the treatment for herpes simplex eye infection?
If the top (superficial) layer is affected - epithelial keratitis
Treatment is with antiviral eye ointment or drops (such as aciclovir ointment or ganciclovir drops). These do not kill the virus but stop it from multiplying further until the infection clears. You should take the full course exactly as prescribed. This is usually several times a day for up to two weeks, sometimes more. The aim is to prevent permanent damage to the cornea. In some cases, a specialist may also gently scrape the affected part of the cornea to remove affected cells.
If the deeper layer of the cornea is affected - stromal keratitis
Treatment is similar to epithelial keratitis (above). In addition to the antiviral eye ointment or drops your specialist may add in some steroid eye drops. This helps to reduce inflammation. Note: steroid eye drops must only be used under close supervision of an eye specialist who will prescribe the correct strength and dose in conjunction with antiviral treatment. Used wrongly on their own, steroid drops cause more harm than good.
Antiviral tablets are used in some cases.
If just the eyelids or conjunctiva are affected
No treatment may be advised. These infections will usually settle on their own in 1-3 weeks. You are likely to be kept under review until the infection goes to check that the cornea does not become infected.
Preventing recurring infections
Some people develop recurring episodes of active infection. As mentioned above, these occur if the virus 'reactivates' from time to time - similar to cold sores. At least half of people who have one episode of active infection will have a recurrence within 10 years of the first. In about 1 in 10 cases, the recurrence is within a year. Recurrences occur more often in some people than others.
If the recurrences are frequent (say, once a year or more) or severe, then your eye specialist may advise that you take antiviral tablets each day to prevent episodes of active infection. Studies have shown that, on average, the number of recurrences is roughly halved in people who take regular antiviral tablets.
Some people say that episodes of active herpes infection may be triggered by strong sunlight. Wearing sunglasses may also help to prevent recurrences.
If a recurrence does occur, each episode is treated as described above.
What is the outlook (prognosis)?
The main concern with corneal infection (keratitis) is that it can cause scarring. With scarring the normally clear and transparent cornea become like 'frosted glass'. This can affect vision.
- Epithelial keratitis tends to settle and go away in 1-2 weeks. It has a good outlook and often causes little or no scarring.
- Stromal keratitis is more likely to result in corneal scarring and loss of vision.
- Recurring episodes of active infection can make any existing scarring worse.
- Prompt treatment with antiviral eye ointment or drops helps to minimise damage during each episode of active infection.
Overall, about 9 in 10 'involved eyes' maintain good vision (good enough to drive). However, severe and recurrent infections may lead to serious scarring and blindness. If blindness develops, a corneal transplant is then the only option to restore vision.
©EMIS and PIP 2004 Updated: September 2004 Review Date: October 2005 CHIQ Accredited PRODIGY Validated
