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  • Q&A with Australian Health Practitioners

    What is herpetic eye disease?

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    I have thirty years in private practice as an optometrist at the same location in Leichhardt and have done four postgraduate courses pertaining to Diseases … View Profile

    Herpetic eye disease is caused by a virus, either herpes simplex or herpes zoster. 
    Both viruses lie dormant in the body until triggered to reactivate.

    Herpes simplex eye infection, usually herpes simplex epithelial keratitis, may be triggered by excessive sun exposure, stress or illness eg fever. A red eye may be accompanied by slight or no eye irritation. It is diagnosed by a characteristic appearance of the cornea on examination. Blisters or vesicles of the skin around the eyes may also be present. There may be a history of cold sores of the lips. Treatment is an antiviral ointment, aciclovir (Zovirax Ophthalmic), five times a day for up to fourteen days.

    Herpes Zoster eye infection, usually Herpes Zoster Ophthalmicus, usually occurs in older adults. It is caused by the same virus that causes chicken pox. Such recurrence of infection is often referred to as “shingles”, and may be triggered by stress or reduced immunity. Usually a burning sensation is followed by a rash on one side of the face or forehead. If vesicles are present on the tip of the nose, ocular involvement is likely. Treatment is an oral antiviral for seven days. “Post-herpetic neuralgia” (persistent pain) is less likely if treatment is commenced within three days of the onset of the rash.       

      

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    Dr John Chang is a Sydney-based ophthalmologist with specialist training in cataract surgery, medical retina and comprehensive ophthalmology. At his Strathfield practice, Dr Chang provides … View Profile

    It’s also important to point out that once herpes virus infection is acquired, it remains dormant and thus herpetic eye disease can recur or reactivate at any time afterwards. It always affects the same eye and so the patient must always be aware of their history and mention their previous herpetic corneal problem or shingles whenever they see their optometrist or ophthalmologist, especially if there is eye redness, pain or reduced vision.

    Herpetic eye disease can affect any part of the eye from the front to the back of the eye. It can also cause corneal scarring, uveitis (inflammation inside the eye), elevation of eye pressure, very painful scleritis, and rarely very serious retinal problems.

    Most cases of red eye are painful, but herpetic eye disease can cause reduced corneal sensation and so a serious eye inflammation from herpes virus may be deceptively painless. So, for health care professionals, please think about the possibility of herpetic eye disease in a person with a red eye and blurry vision but without eye pain. 

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