Herpes and the Eye

When we think of herpes we typically think of the venereal disease or cold sores. Many people are not aware that chicken pox and shingles are also caused by a form of the herpes virus, or that it is the leading cause of infectious blindness in the United States. Herpes affecting the eye is called ocular herpes. About 400,000 Americans have some form of ocular herpes, and there are nearly 50,000 cases of the disease diagnosed every year.

Causes
Herpes is transmitted through bodily fluids. Nearly everyone is exposed to the virus during childhood and the symptoms are typically mild enough that it goes undetected. After that, the virus lies dormant in nerves which run to the skin and eyes. It can be reactivated by sunlight, heat, fever, stress, hormonal changes, certain medications, dental or surgical procedures, or trauma.

Herpes is transmitted to the eye by contact with another person who is having an outbreak, or through contact with a part of your own body where there is an outbreak, and then touching your eye.

Symptoms
Ocular herpes affects the eyelids, conjunctiva, and cornea. It can result in ongoing eye infections and eventually scarring of the cornea leading to blindness. Symptoms of ocular herpes can include:

Pain
Irritation
Scratchiness
Redness
Tearing
Light sensitivity
Recurring infections
Decreased vision
Vision Impairment
Vision loss caused by ocular herpes is usually minimal, but about 6% of people who have the disease develop stroma keratitis. Stroma keratitis involves the deeper layers of the cornea and can cause scarring and corneal thinning. The globe of the eye can actually rupture resulting in blindness. When ocular herpes affects the iris it is called iridocyclitis. Iridocyclitis causes inflammation of the iris and surrounding tissues resulting in pain, redness, severe sensitivity to light, and blurred vision.

Diagnoses and treatment
Ocular herpes can be detected by a slit lamp test. Treatment normally involves the use of anti-viral eye drops and/or oral medications. Steroid drops may also be used to decrease inflammation and prevent scarring. Sometimes debridement is required. Debridement involves scraping off the infected corneal epithelial cells. In severe cases a corneal transplant is necessary.

Ocular herpes and LASIK
If you have ocular herpes and are considering LASIK surgery, you must discuss your condition with your ophthalmologist. Ocular herpes does not always mean that you cannot have LASIK procedures, but it does increase the risk of complications and even blindness. LASIK surgery may be interpreted by your body as trauma – one of the things that can cause ocular herpes to flare up. Certain immune responses to ocular herpes can advance the damage it causes to the cornea. Immunocompromised patients are at the greatest risk. They are more likely to experience a flare up and if they do, it is more likely to be severe. The benefits vs. risks should be evaluated on a case by case basis. If you, and your ophthalmologist, decide that LASIK surgery is still appropriate, precautions can be taken to minimize the risks.

If you are considering LASIK surgery and have ocular herpes talk to an experienced ophthalmologist today.