Herpes Simplex //
Ninety percent of adults have had an infection by the herpes simplex type I virus by their late twenties. Usually, the initial herpes simplex infection is associated with flu-like symptoms or is asymptomatic and goes unrecognized. After the initial infection, the herpes virus remains in the body in an inactive (“latent”) state. Recurrent fever blisters (“cold cores”) on the lips or nose represents a reactivation of the latent herpes virus.
Occasionally, herpes simplex virus type l infects the eye. This is called ocular herpes simplex disease. It is unclear why some individuals develop herpes infections in or around the eye, instead of the much more common infections involving the lips or nose. Factors such as the particular strain of the virus that one has been infected with and one’s immune system most likely play a role. Ocular herpes simplex disease is usually not acquired sexually and is only rarely cause by herpes simplex type II (the virus that causes genital herpes.)
In ocular herpes simplex disease, the virus may infect the conjunctiva (the mucous membrane that covers the white portion of the eye), cornea, or involve the inside of the eye. Ocular herpes simplex infections are potentially serious because they can result in permanent damage to the eye and loss of vision. Once a person develops an herpes simplex infection, there is a significant chance of having a recurrence - approximately 30% - within two years. The recurrences are often more severe, more difficult to treat and lead to progressive damage to the cornea and other ocular structures. Chronic inflammation or problems with surface healing are sometimes seen. These problems can lead to corneal ulceration, progressive corneal scarring and damage to the inside of the eye resulting in the development of cataracts and glaucoma.
Treatment typically involves the use of a topical antiviral agent (drops/gel). This may be cautiously combined with an anti-inflammatory agent when inflammation is causing serious damage. Close monitoring and frequent changes in medication are needed to properly care for infection/inflammation due to herpes simplex virus. In rare situations, ocular surgery or corneal transplantation may be indicated. Prophylactic treatment with an oral antiviral agent may be indicated in patients with frequent recurrences or smoldering disease.
Factors which affect recurrences and long term prognosis are poorly understood. Various types of stress (physical or emotional), certain foods, or exposure to intense sunlight have played a role in reactivation of the virus in some patients. Patients with severe allergies and eczema may have more severe herpetic skin and eye infections.
Fortunately, the majority of patients with ocular herpes simplex disease have localized involvement and maintain good vision. Most initial episodes resolve within two to three weeks of treatment. The risk of having a recurrent infection, even years later, however, needs to be kept in mind. Patients with a history of herpes simplex ocular disease should notify their ophthalmologist without delay if they develop signs of a flare-up such as eye pain, redness, or blurred vision.