How the virus gets into the eye and what forms it comes in
Most people are exposed to the herpes simplex virus during childhood, often without symptoms. The virus remains in the trigeminal ganglion and, when the protection is weakened, descends along the nerve fibers to the eye. The trigger is a cold with a high fever, hypothermia, severe stress, sunburn, surgery or injury. The forms differ in the depth of the lesion: from superficial inflammation of the conjunctiva and eyelids to deep damage to the cornea and choroid. Separately, herpes zoster of the ophthalmic branch of the trigeminal nerve, caused by another virus, is distinguished.
- Herpetic blepharitis and conjunctivitis
- Superficial dendritic keratitis
- Stromal keratitis with opacification of deep layers
- Keratouveitis and uveitis
- Neurotrophic keratopathy after inflammation
- Retinal damage is a rare but severe form
Symptoms
The onset is usually unilateral. There is a feeling of speck under the eyelid, the eye turns red and watery, it becomes difficult to look at the light. When the cornea is damaged, blurred vision occurs, and the pain can be severe. A characteristic symptom is a decrease in the sensitivity of the cornea: the eye is damaged, but the person almost does not feel the usual burning sensation. Sometimes small blisters with a reddened base appear on the skin of the eyelid, the wing of the nose or the forehead, which then dry out in crusts.
- Redness and watering of one eye
- Photophobia and involuntary squinting
- Foreign body sensation
- Blurred and decreased vision
- Pain in and around the eye
- Blisters on the skin of the eyelid and near the nose
Diagnostics
The basis is slit lamp examination. The doctor instills fluorescein dye, and under blue light a tree-like ulcer with thickened edges becomes visible - almost a calling card of herpes. The sensitivity of the cornea is checked, the anterior chamber and intraocular pressure are assessed, and the fundus is examined. Laboratory confirmation is needed in doubtful and severe cases: a scraping is taken from the conjunctiva or cornea and examined by PCR. Blood tests for antibodies show the fact of an encounter with the virus, but do not prove that it is the virus that has affected the eye now.
- Biomicroscopy with fluorescein staining
- Corneal sensitivity assessment
- PCR scraping for herpes simplex virus
- Antibodies of the IgM and IgG class with an unclear picture
- Tonometry and fundus examination
- Ultrasound of the eye in opaque media
Treatment
The ophthalmologist selects treatment depending on the form. For superficial keratitis, antiviral drugs in the form of ophthalmic forms, sometimes in combination with systemic tablets, become the basis. In case of deep stromal inflammation, anti-inflammatory drugs, including hormonal ones, are added to them, but they are prescribed only by a doctor and only under control: with an open corneal ulcer, hormones without antiviral cover can lead to its melting. Additionally, agents are used that restore the epithelium and moisturize the eye. If there is severe corneal opacity, a corneal transplant is discussed in the future.
- Antiviral drugs locally and orally as prescribed by a doctor
- Agents that restore corneal epithelium
- Artificial tear preparations without preservatives
- Pupil dilating drops for choroidal involvement
- Hormonal drops - only under the supervision of an ophthalmologist
- Control examinations until complete healing
Relapse Prevention
It is impossible to completely remove the virus from the body, so the task is to reduce the number of exacerbations and protect the cornea. For people with frequent relapses, the doctor may prescribe long-term prophylactic use of an antiviral drug. Simple things help: sunglasses, avoiding rubbing your eyes, being careful with contact lenses, treatment of chronic diseases and normal sleep. When the first familiar sensations appear, it is important not to wait and not to drip “what helped last time,” but to see a doctor: each new attack adds scars.
- Do not prescribe yourself hormonal drops
- Wearing sunglasses on a bright day
- Do not rub your eyes or wash your hands if you have cold sores on your lips.
- Follow the rules for wearing contact lenses
- Treat concomitant diseases, maintain sleep patterns
- Contact an ophthalmologist at the first symptoms of relapse
