Ocular herpes is caused by an infection with the type 1 herpes simplex virus. The condition tends to recur over time and can range from a sore on the eyelid to scarring of the cornea and possibly loss of vision. There are three main types of ocular herpes infection: herpes keratitis, or a surface corneal infection; stromal keratitis, or an infection deeper inside of the cornea; and uveitis, which is located inside of the eye. Treatments for ocular herpes vary depending on the location of the infection.
Debridement
For surface or epithelial corneal disease, some eye doctors remove the epithelial cells with a swab or other instrument. This process is called debridement. A bandage contact lens is then placed on the cornea for weeks to months to allow the eye to heal. Debridement can be used in conjunction with other medications to treat ocular herpes.
Antiviral Medications: Eye Drops and Ointments
There are several types of antiviral eye drops and ointments that can be used to treat surface ocular herpes. Antiviral eye drops may need to be placed in the eye up to every hour depending on the severity of the infection. The eye drops and ointments can be used in conjunction with oral antiviral medications or steroid eye drops.
Antiviral Medications: Oral
Oral antiviral medications can be used instead of antiviral eye drops or ointments or at the same time. After the infection has improved, it has been found that some oral antiviral medications may decrease the incidence of recurrence of ocular herpes in some patients.
Steroid Eye Drops
When the infection is located deeper in the cornea, steroid eye drops are used to decrease scarring of the stroma of the cornea. Stromal infection is harder to treat; this scarring can lead to vision loss. Steroid eye drops are also used when the infection causes inflammation in the front of the eye (iridocyclitis). Antiviral medications are almost always used with steroid eye drops. Also, in some patients, the eye doctor will prescribe antibiotic drops along with steroid eye drops because steroids can lower the effectiveness of the immune system.
Injected Steroids
If the herpes infection affects the back of the eye (posterior uveitis), the doctor may inject steroid medications into the back of the eye to treat the inflammation.The doctor will monitor all patients who receive steroids closely because steroids can cause eye pressure elevation or glaucoma in susceptible patients.
Corneal Transplant Surgery
A small number of patients have recurrent episodes of stromal infection with residual scarring that significantly impacts vision despite treatment. For these patients, the best treatment option is a corneal transplant. Patients with ocular herpes who receive a corneal transplant are at a higher risk of that transplant failing, but research suggests that extra testing before the surgery may help clinicians better prepare the eye and lower the risk of rejection.
