Primary infection of the eyes with herpes most often occurs in early childhood. The first case of the disease usually proceeds easily and resembles the usual conjunctivitis (Figure 1-3). The latter usually passes quickly without complications and without involving the cornea. If the cornea is still involved, then lacrimation and photophobia join the conjunctiva redness.
In some cases, in addition to these symptoms, a rash of herpetic vesicles on the eyelids may appear (Figure 4-5), i.e. vesicular blepharitis. The bubbles that form after a few days burst, leaving ulcerations that heal without scarring in about 7-10 days. In parallel, some blurring of vision is possible.
Herpetic conjunctivitis -
Herpes on the eyelid of the eye (blepharitis) -
Primary eye herpes occurs precisely in early childhood - due to the gradual decrease in this period of the residual amount of antibodies to the herpes virus, which were received from the mother during pregnancy. Moreover, if the herpes on the eye occurs against the background of a still quite high level of antibodies in the serum - symptoms are usually weak and may be limited by conjunctivitis.
If the background is low in antibodies, the eyelids and corneas of the eye may be affected. In many patients, after recurring primary infection, repeated relapses of the disease may develop. According to statistics, in 10% of patients the first relapse occurs already during the first year. In contrast to the primary herpes of the eyes - a chronic recurrent form of the disease can lead to significant corneal lesions, deterioration and even loss of vision.
Herpes eye: causes
There are many types of herpes virus - the so-called herpesvirus family. However, only 3 types of herpeviruses cause eye damage. Most often, it is type 1 herpes simplex virus (HSV-1), less often type 2 herpes simplex virus (HSV-2) and shingles virus (HSV-3). Herpes on the eye caused by the types of viruses HSV-2 and HSV-3 - are much more difficult to treat.
After the initial infection and recovery, the herpes virus persists in the sensory and autonomic nerve ganglia. This explains why the herpes virus primarily affects the lips, the cornea of the eye, the oral mucosa and the genitals. The fact is that a large number of sensory nerve fibers are concentrated in these tissues of the body. And with a decrease in immunity, the virus is activated, causing a recurrence of the disease.
Contact of the herpes virus on the cornea of the eye can occur through direct contact with a person with active clinical manifestations of herpes. In addition, you can carry the virus yourself, if you have active herpes on the lip or herpes stomatitis. It is enough to spit on your fingers or touch your lips with your hand, and then rub your eyes. You can even transfer herpes from the lips to the eye area, just wiping with a towel.
In children -
especially often, herpetic eye disease develops in children. Young children are constantly pulling their hands in their mouths, licking them. And if a child has herpes on the lip, the skin around the mouth, or on the oral mucosa, this virus will definitely be everywhere, including the eyes. Therefore, it is very important in young children on the background of herpetic stomatitis or lip herpes - to bury special drops in the eyes, such as Ophthalmoferon.
Repeated outbreaks of ocular herpes -
Repeated cases of the disease are usually manifested by epithelial keratitis (lesion of the corneal surface). Epithelial keratitis is manifested by tearing, photophobia, foreign body sensation in the eye. But the most important diagnostic criterion is the formation of a corneal defect in the form of tree branches (because of which epithelial keratitis is often also called tree-like or serpentine). This form of keratitis can be cured without a trace, usually within 1-2 weeks.
Herpes on the eye: photo of epithelial keratitis
In some cases, herpetic lesions can occur not only in the corneal surface, but also in its deeper layers (stroma), which indicates the development of stromal keratitis. The latter is divided into disc keratitis - in this case, the main diagnostic criterion will be the appearance in the cornea of the site of turbidity and edema, having the form of a disk. With disc keratitis, there is no stromal necrosis.
The second form of stromal keratitis is necrotizing keratitis, which proceeds with necrosis of the corneal stroma. Visually, areas of necrosis appear as whitish-cloudy infiltration in the corneal stroma (can occur with or without damage to the corneal epithelium). Infiltration can be only one large size, or multiple small infiltrates. The development of such necrosis is usually associated with the pathological reaction of the patient’s immune system.
Complaints of patients with stromal keratitis -
- severe pain
- blurred vision
- sensitivity to light (photophobia),
- feeling of "sand in the eyes."
The diagnosis is made by an ophthalmologist. As a rule, it is enough to have an examination with the help of a special slit lamp, but in case of disputable cases, microbiological research (seeding on a viral culture) can sometimes be prescribed. It is very important to distinguish herpes eyes caused by the herpes simplex virus types HSV-1 and HSV-2 - from the virus type HSV-3, which causes herpes zoster (in which eye damage also occurs).
Herpes on the eye: treatment and prevention
Tactics of treatment will depend on whether the herpes virus has a primary or secondary lesion of the eye, as well as on the severity of symptoms. Herpes on the eye - treatment of a child in the first case of the onset of the disease (provided that only the symptoms of conjunctivitis are observed) is possible with the help of Ophthalmoferon. Scheme - 1-2 drops 8 times a day (until the symptoms pass). If we are talking about a younger child, then in parallel, you can use the drug Viferon in the form of candles.
If, in addition to conjunctivitis, herpes appeared on the eyelid of the eye, treatment in addition to the drops Ophthalmoferon should include 5% cream with Acyclovir. Cream with acyclovir in 5% concentration can be applied only on the eyelids and skin around the eyes. If epithelial keratitis has developed, then you need to keep in mind that for the lower eyelid, you can lay only a special eye ointment with 3% Acyclovir.
With mild clinical manifestations of the above drugs is enough to cope with the first encountered herpes eyes. However, in very rare cases, newborns can have very severe clinical manifestations. In this case, an emergency consultation of an ophthalmologist and therapy with systemic antiviral drugs are needed.
Treatment of recurrent outbreaks of herpes -
As we have said above, with repeated outbreaks of herpes, epithelial or stromal keratitis develops. With adequate treatment, epithelial keratitis disappears within 1-2 weeks, and ends with complete healing. However, in the absence of proper treatment, approximately 25% of patients transform epithelial keratitis into stromal keratitis (which in turn can lead to scarring of the cornea and sometimes even loss of vision).
1. Local treatment -
Epithelial keratitis is perfectly treated with local remedies. In Europe and the United States for this approved 2 drugs. Firstly - 0.15% Ganciclovir gel (according to the scheme - 5 times a day / i.e. every 3 hours). Secondly, 1% Trifluridine solution in the form of drops (according to the scheme - 9 times a day / every 2 hours after waking up). The problem is that for Russians these modern drugs are not available, because we just do not sell them.
Therefore, there is only one alternative - Acyclovir eye ointment 3%. There is an original drug - this is Zovirax (UK) - at a price of 280 rubles for a tube of 4.5 g. Alternatively, you can use an inexpensive Russian-made ointment (manufacturer Synthesis, Kurgan) - at a price of 120 rubles for a tube of 5 g.
Application Scheme -
eye ointment for adults and children is placed in the lower conjunctival sac (for the lower eyelid) - 5 times a day at intervals of 4 hours. Each time it uses a strip of ointment 10 mm. The treatment lasts while there are symptoms + 3 more days after healing.
Treatment of stromal keratitis -
With stromal keratitis, local glucocorticoids may be prescribed. Note that they can not be used for epithelial keratitis! But with stromal they should be used in combination with antiviral agents. For example, a 1% prednisone solution can be used. At the first stage of treatment - every 2 hours, with a subsequent increase in the interval - up to 4-8 hours. Alternative prednisolone drug - 0.1% dexamethasone solution.
You also need to monitor intraocular pressure and when it is raised - to prescribe the appropriate treatment. For the treatment of concomitant photophobia, 1% atropine solution or 0.25% scopolamine solution can be used (both drugs - 3 times a day). Remember that using glucocorticoids without a doctor's prescription is by no means impossible.
2. Systemic treatment -
In some cases, can be assigned or pill form - acyclovir or valacyclovir, or acyclovir in the form of intravenous infusions. The effective dosage of acyclovir for children over 2 years old and adults - 400 mg per 5 times a day. For children under 2 years old - 200 mg 5 times a day. Valacyclovir is prescribed - 1000 mg 2 times a day. The duration of therapy in each case is 3 weeks (21 days).
Treatment of adults with weakened immunity is carried out with an increased dosage of acyclovir up to 800 mg (5 times a day, for 3-4 weeks), or the intravenous form of acyclovir can be used. With the resistance of the herpes virus to acyclovir / valacyclovir, famciclovir can be prescribed 500 mg 2 times a day.
Ophthalmic herpes zoster -
Herpes on the eyes can be caused not only by the herpes simplex virus (Herpes simplex, types HSV-1 and HSV-2), but also by the herpes virus Herpes Zoster type HSV-3, which causes herpes zoster (synonym - shingles). During the exacerbation of the herpes zoster virus, the eyes may also be involved in the process, and herpes sores occur along the first branch of the trigeminal nerve.
The very first symptom that appears even in the prodromal stage of the disease (that is, until the onset of herpetic eruptions) is showing in the tip of the nose. In the acute phase of the disease, the symptoms are usually very pronounced, including rash on the eyelids, the skin around the eyes, the skin of the forehead, and very often on the tip of the nose. There may be very strong pain in the forehead, severe swelling of the eyelids, photophobia.
In more than half of all cases, inflammation of all tissues of the anterior and sometimes the posterior part of the eye occurs. Herpes eyes, caused by Herpes Zoster, can be severe and very often accompanied by scarring of the cornea. As consequences, cataract, glaucoma, chronic uveitis, corneal scarring, postherpetic neuralgia, etc. may occur. (all these complications impair vision).
The diagnosis is made on the basis of the characteristic rash on the forehead, the tip of the nose and on the eyelids, as well as on the basis of the results of eye examinations. Atrophic hypopigmented lesions that have arisen at the site of past herpetic eruptions on the forehead can tell about the traces of the herpes zoster already transferred in the past in the eye area. A herpetic lesion of the forehead and skin around the eyes, which has not yet spread to the eyeball, indicates a high risk and requires urgent advice from an ophthalmologist.
The basis of the treatment of ophthalmic herpes zoster is a tablet antiviral agents (acyclovir, valacyclovir, famciclovir). In some cases, it is advisable to use local glucocorticoids, for example, 1% prednisolone solution or 0.1% dexamethasone solution.
Treatment with acyclovir in children older than 2 years and adults should be carried out according to the schedule - 800 mg orally 5 times a day (for 7-10 days). The use of famciclovir in adults is 500 mg 3 times a day (7 days total), valaciclovir is 1000 mg 3 times a day (7 days total). It is noted that pain syndrome is much less precisely when using valciclovir and famciclovir, but these drugs will be much more expensive.
In patients with weakened immunity or neurological complications requiring hospitalization, acyclovir is usually used intravenously at the rate of 10 mg / kg body weight, infusion every 8 hours (for 7-10 days). In the absence of the effect of treatment with acyclovir, Foscarnet is used in such patients at the rate of 40 mg / kg, every 8 hours until all foci heal.
Herpes Prevention -
- try not to contact people who have active herpetic eruptions,
- strengthen your immunity
- wash your hands regularly
- if you have herpes on the lip - wash your towels regularly, and also change the pillow case from the pillow after each use (especially in children), otherwise there is a big risk of herpes spreading from the lip to the eye area,
- in case of the occurrence of herpetic stomatitis in children, it is desirable to prophylactically bury Oftalmoferon in the eyes (because they very often lick the fingers, and then rub their eyes)
- do not use any personal belongings of a person who has become sick with herpes,
- use sunscreen on your face and lip balm containing zinc oxide if you plan to stay in the sun for a long time.
Vaccination is possible for patients with severe recurrent outbreaks of herpes. The Russian vaccine "Vitagerpavak" is intended for the prevention of herpes simplex type 1 and 2. This is a new vaccine, and it is still difficult to clearly speak about the degree of its effectiveness, but for patients with frequent outbreaks, we would recommend it as one of the prevention options. We hope that our article: Herpes on the eye photo, treatment and symptoms - turned out to be useful to you!
Author: dentist Kamensky K.V., 19 years experience.