What are the symptoms of ocular herpes?
The symptoms of eye herpes can vary slightly depending on which virus causes it, and most are symptoms that can happen with several other conditions. Some symptoms affect the eye itself, while others affect the surrounding parts of your face, too. It usually affects one eye at a time but can sometimes affect both simultaneously.
Herpes simplex virus-related symptoms
Typical symptoms of HSV-related herpes include:
- Eye pain.
- Eye irritation and redness.
- Feeling like something’s in your eye (foreign body sensation).
- Light sensitivity (photophobia).
- Watery or teary eyes (epiphora).
- Eyelid swelling or inflammation (blepharitis).
- Pink eye (conjunctivitis), possibly with cornea inflammation (keratoconjunctivitis).
- Clusters of bumps or blisters filled with fluid (vesicles) or pus (pustules) on your eyelids or around your eyes.
- Corneal ulcers or other changes.
More severe symptoms can include:
- Worsened vision.
- Iris inflammation (iritis).
- Sudden or rapid vision loss.
Varicella zoster-related symptoms
Varicella zoster can cause many eye symptoms. But it also commonly causes skin symptoms around your eye, particularly on your forehead. The virus mainly attacks your nervous system, and the trigeminal nerve branches in your forehead are a common place for those symptoms to appear.
Eye symptoms can include:
- Eyelid swelling or inflammation (blepharitis).
- Swelling of the cornea or conjunctiva.
- Reddening or swelling of the white of your eye (episcleritis).
- Watery discharge from your eye, especially with episcleritis.
- Droopy eyelid (ptosis).
- Painless vision loss (this is a rare — but severe — complication).
Skin symptoms usually affect one side of your face and may include:
- Rash.
- Blisters or bumps (vesicles or pustules) which rupture and scab or crust over on your forehead or nose.
- Itching.
People with varicella zoster-related eye herpes usually have general symptoms like nerve pain, fatigue or malaise (a general “unwell” feeling) before any visible eye or skin symptoms appear.
What causes ocular herpes?
Eye herpes can happen with two strains of herpes simplex (types 1 and 2) or the varicella zoster virus. These viruses are highly contagious, meaning it’s very easy for you to catch them from other people. But there are a few important differences in how that can happen with herpes viruses and the varicella zoster virus.
HSV-1
It’s easy for oral herpes to spread to your eyes from your hands (for example, you touch an open sore on your lip and then touch your eye). It can cause eye herpes when it first infects you (primary infection). But it’s more common for it to affect your eyes (either traveling through your nerves or spreading via your hands) when the virus reactivates.
HSV-1 spreads easily between people through infected saliva and other bodily fluids. That can happen directly through person-to-person contact like kissing. It can also happen indirectly through shared objects like eating and drinking utensils, hygiene items, makeup and others).
Oral herpes commonly causes sores or blisters (sometimes called “cold sores” or “fever blisters”) on your lips or around your mouth. But the initial infection can sometimes look like an upper respiratory illness or another viral condition like mononucleosis (especially in adults).
After your immune system reacts to HSV-1, the virus can go dormant and hide in your nervous system. It can then reactivate and cause a symptomatic infection (and potentially eye herpes) later.
HSV-2
HSV-2 is mainly a sexually transmitted infection (STI). But in uncommon cases, HSV-2 can spread through bodily fluids to your face or eyes (either via your hands or directly). This can cause ocular herpes in babies and young children.
A pregnant person can also pass HSV-2 to a fetus during pregnancy, and a birthing parent can pass the virus to their baby during childbirth. Experts call this “vertical transmission.” It’s one of the main ways that newborns can contract (catch) HSV-2 and later develop eye herpes. Research shows vertical transmission happens in about 1 in every 3,200 births each year.
Varicella zoster
Varicella zoster causes chickenpox in children and adults. Once you have chickenpox, the varicella zoster virus goes dormant and hides in your nervous system (just like HSV does). It can then reactivate at some point later in your life — sometimes years or even decades later — and cause shingles. Shingles can spread through your nervous system and reach your eyes through nerves that pass close by.
While the varicella zoster virus causes both chickenpox and shingles, it’s only shingles that can cause eye herpes. It’s rare for chickenpox to affect your eyes, and experts don’t classify it as eye herpes when it does. Eye herpes also isn’t contagious like shingles on your skin.
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Can I get ocular herpes more than once?
Yes, you can have eye herpes more than once. Several potential risk factors may contribute to flare-ups. They include:
- Stress.
- Fever.
- Ultraviolet laser eye treatments.
- Topical eye medications, including beta-blockers, corticosteroids, epinephrine and prostaglandins.
- Menstruation.
- Immune-suppressing medications or conditions (having eye herpes in both eyes can indicate an underlying immune condition).
- Another recent infection that could’ve weakened your immune system.
What are the complications of ocular herpes?
The most serious complication of eye herpes is vision loss or blindness. Both types of HSV and varicella zoster can damage structures throughout your eyes. Most of the time they affect the cornea, but they can also affect the uvea and the retina. Recurrences (when the virus reactivates) can cause scarring, which leads to permanent vision loss. That’s why eye herpes is a condition that needs quick diagnosis and treatment.
