HSV-1 Cold Sore Virus And Your Eyes

Over our various blog articles, we have discussed how cold sores affect parts of the body other than the lips and other cold sore facts. While the HSV-1 and HSV-2 virus strains are the most common, there’s also the Herpes Zoster or HZV, Cytomegalovirus or CMV, and others.

How Can Cold Sore Virus Affect My Eyes?

HSV-1 is the most common strain to affect the eyes, which is also the strain that causes cold sores. Herpes Zoster, the same strain that causes chickenpox in children and shingles for adults, can also affect the eyes.

The cornea of the eye is the most susceptible part of the eye to infection. When the cornea of the eye becomes infected or inflamed, it’s referred to as keratitis. HSV-1 and HZV can also affect the skin of the eyelids, iris, and the retina.

1. HSV-1: The Most Common Cause of Herpes Eye Infections

HSV-1 is the leading cause of ocular herpes, often due to reactivation of a latent virus in the trigeminal nerve.

Types of Eye Infections Caused:

  • Herpes Simplex Keratitis (HSK): Infection of the cornea

    • Symptoms: Eye pain, redness, blurred vision, photophobia, tearing

    • Types:

      • Epithelial keratitis: Virus replicates in corneal cells (dendritic ulcers visible with fluorescein)

      • Stromal keratitis: Immune response damages deeper corneal layers → scarring and vision loss

  • Conjunctivitis: Redness and irritation in the eye

  • Iridocyclitis: Inflammation of the iris and ciliary body

  • Retinitis (rare): Inflammation of the retina, more severe and vision-threatening

2. HSV-2: Rare in the Eye, but More Serious When It Happens

HSV-2 is less likely to affect the eye in adults but can do so in neonates infected during vaginal delivery.

Neonatal HSV-2 Ocular Infection:

  • May involve:

    • Conjunctivitis

    • Keratitis

    • Chorioretinitis (posterior eye involvement)

  • Often part of disseminated or CNS disease in newborns

  • Requires urgent antiviral treatment (e.g., IV acyclovir)

🧪 Diagnosis

  • Clinical exam using slit-lamp and fluorescein dye

  • PCR or viral culture (from conjunctival swabs or corneal scrapings)

  • Serologic testing if needed

💊 Treatment

  • Topical antivirals (e.g., trifluridine, ganciclovir gel) for epithelial keratitis

  • Oral antivirals (e.g., acyclovir, valacyclovir) for stromal or recurrent infections

  • Topical corticosteroids sometimes used with antiviral cover for stromal disease

  • Avoid steroids alone — they can worsen HSV eye infections

⚠️ Complications

  • Corneal scarring

  • Vision loss

  • Recurrent flare-ups

  • Glaucoma (from uveitis or steroid use)

If you’re experiencing eye symptoms and suspect HSV, it’s crucial to see an ophthalmologist immediately, as early treatment greatly reduces the risk of permanent damage.

Herpes Simplex Virus Type 1 (HSV-1) is the most common viral cause of eye infections, especially affecting the cornea and conjunctiva. Ocular HSV-1 can be recurrent and vision-threatening if not properly managed.

👁️ How HSV-1 Affects the Eyes

1. Herpes Simplex Keratitis (HSK)

This is the most common manifestation of HSV-1 in the eye.

Types of Keratitis:

Type Description Key Signs
Epithelial Keratitis Active viral replication in superficial cornea Dendritic ulcers (branching lesions) seen with fluorescein dye
Stromal Keratitis Immune-mediated inflammation of deeper corneal layers Hazy cornea, decreased vision, potential for scarring
Endothelitis Inflammation of innermost corneal layer (endothelium) Corneal edema, blurred vision, keratic precipitates

2. Herpes Simplex Conjunctivitis

  • Red, irritated eye

  • Watery discharge

  • Often unilateral

  • May precede keratitis or occur on its own

3. Iridocyclitis (Anterior Uveitis)

  • Inflammation of iris and ciliary body

  • Pain, photophobia, blurred vision

  • Often occurs with keratitis

4. Herpetic Retinitis (rare)

  • A rare but severe posterior segment infection (e.g., Acute Retinal Necrosis)

  • Can lead to permanent blindness if untreated

🔁 Recurrence

  • HSV-1 can reactivate from latency in the trigeminal ganglion

  • Triggers: Stress, fever, UV light, trauma, immunosuppression

  • Each recurrence increases risk of corneal scarring and vision loss

🧪 Diagnosis

  • Slit-lamp exam with fluorescein staining (dendritic ulcers are classic)

  • PCR testing or viral culture from corneal scrapings

  • Confocal microscopy or serologic tests in atypical cases

💊 Treatment

Condition Treatment
Epithelial keratitis Topical antivirals (e.g., trifluridine, ganciclovir gel), oral antivirals (e.g., acyclovir)
Stromal keratitis Oral antivirals + topical corticosteroids (only under ophthalmologist’s guidance)
Uveitis Oral antivirals + topical corticosteroids
Prophylaxis (recurrent disease) Daily oral acyclovir or valacyclovir may reduce recurrences

⚠️ Complications

  • Corneal scarring

  • Vision impairment or blindness

  • Secondary bacterial infection

  • Glaucoma (from chronic inflammation or steroid use)

🩺 When to See a Doctor

Seek immediate ophthalmologic evaluation if you experience:

  • Sudden eye pain, redness, or light sensitivity

  • Blurred or decreased vision

  • Recurring eye irritation with a history of cold sores or HSV

Early diagnosis and proper antiviral treatment are key to preventing long-term visual damage.

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