HERPES SIMPLEX

Herpes simplex is the name of a virus. There are different forms of this virus that can affect many different parts of the body. Herpes is divided into Types I and II. Type I Herpes simplex is the form that more commonly infects the eye. It is also the type that causes fever blisters or cold sores around the mouth. Herpes simplex Type II is the sexually transmitted form of the virus. Although Type II can infect the eye, it is much less common.

Herpes infections of the eye tend to be troublesome for several reasons. Many areas of the eye are affected. The infections tend to be recurrent, meaning that they can come back again and again. Scarring from the infections can cause a significant loss of vision.

Herpes can infect all layers of the eye. The first infection with Herpes tends to be a conjunctivitis that looks like any viral conjunctivitis. It resolves on its own. Next, the cornea is usually infected. The corneal infection with Herpes can be just on the surface, or deep within the stroma, the middle layer of the cornea. There are specific anti-viral medicines that can be used to treat this type of infection. Later on, the virus can involve the inner layers of the eye, causing inflammation and tissue damage. In this situation, antiviral medicines are sometimes combined with anti-inflammatory medicines to try to prevent injury to the eye.

Herpes infection is "recurrent." This means that it continues to come back to affect the same area of the body, over and over again. Herpes is never cured, it is only treated and controlled. When someone is infected with the Herpes virus, the virus hides inside the roots of nerves. At times, the virus is said to "reactivate," meaning that it comes out of hiding in the nerve and infects the areas supplied by that nerve root. With respect to the eye, the virus hides inside a structure called the ciliary ganglion.

Each time someone has a flare-up of the Herpes infection, he or she develops some scarring in the area involved. If this area of scarring is in the pathway for vision, the eyesight can be damaged.

Treatment of Herpes simplex in the eye is a difficult, long- term project. Anti-viral medicines can help to control the occasional flare-ups. When inflammation develops, multiple medicines become necessary. If inflammation is severe, scarring, or even "melting" of the tissues occurs. Corneal transplantation is sometimes done to improve vision when Herpes damages the cornea. Unfortunately, the infection can even come back in a transplanted cornea.

Anyone with suspected Herpes infection of the eye should be evaluated promptly by an ophthalmologist.

Copyright, 1997. Richard E. Gans, M. D.

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