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.
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
|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|
|Iris atrophy (uncommon)|
|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.
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