Herpes Around the Eyes: Symptoms, Risks, and Treatment

Herpes around the eyes is a serious medical condition that can threaten vision if left untreated. Herpes simplex keratitis — HSV infecting the cornea — is the most common infectious cause of corneal blindness in high-income countries; it presents with eye pain, photophobia, and a characteristic dendritic (branching) corneal ulcer visible only with fluorescein staining; and topical corticosteroids, often prescribed for red eyes, can dramatically worsen the infection.

Two Different Viruses Cause Ocular Herpes

An important distinction that most consumer articles miss: "eye herpes" can be caused by two different herpesviruses, and they're clinically different.

Herpes simplex (HSV-1, occasionally HSV-2) causes herpes simplex keratitis and herpes simplex blepharitis. The virus typically reaches the eye through autoinoculation — touching an active oral cold sore and then rubbing the eye — or through reactivation of HSV latent in the trigeminal ganglion that travels to the ocular branch of the trigeminal nerve. HSV keratitis most commonly affects one eye.

Herpes zoster ophthalmicus (HZO) is caused by varicella-zoster virus (VZV) — the same virus that causes chickenpox and shingles, not HSV. It occurs when VZV reactivates in the ophthalmic branch of the trigeminal nerve. HZO produces a characteristic unilateral vesicular rash following the dermatomal distribution of the forehead and around one eye, along with ocular inflammation. VZV and HSV require different antivirals (acyclovir or valacyclovir for both, but different doses).

Herpes Simplex Keratitis: What It Looks and Feels Like

HSV keratitis (infection of the cornea) presents with: eye pain, often described as gritty or foreign body sensation; photophobia (light sensitivity); excessive tearing; blurred vision; and redness of the conjunctiva. The diagnosis is confirmed with fluorescein staining under a slit lamp, revealing the characteristic dendritic ulcer — a branching, tree-like pattern on the corneal surface that is pathognomonic for HSV keratitis.

Herpes simplex blepharitis (affecting the eyelids rather than the cornea): vesicles or small ulcers on the eyelid margins, lid swelling, and crusting. This is less vision-threatening than keratitis but requires antiviral treatment to prevent progression.

The Steroid Danger

Topical corticosteroid eye drops (prednisolone, dexamethasone) are commonly prescribed for non-specific red eye. Applied to an eye with active HSV keratitis, they suppress the immune response that is limiting the infection, allowing rapid viral replication and corneal destruction. HSV keratitis that is treated with topical steroids without antiviral cover can progress rapidly to corneal perforation. If you have a red, painful eye with photophobia, don't accept a prescription for topical steroids without HSV keratitis being excluded first by fluorescein staining under a slit lamp.

Treatment

Acute HSV keratitis: topical ganciclovir 0.15% ophthalmic gel five times daily, or topical acyclovir 3% ointment five times daily, for 14 days. Oral valacyclovir 500mg twice daily is an alternative. Topical steroids are only used in combination with antivirals for stromal (deeper) keratitis under ophthalmological supervision. Long-term suppression: oral acyclovir 400mg twice daily or valacyclovir 500mg daily significantly reduces recurrence rates in patients with frequent recurrent HSV keratitis — the HERPETIC EYE DISEASE STUDY demonstrated a 45% reduction in recurrence with long-term suppressive therapy.

Frequently Asked Questions

Can you go blind from eye herpes?

Yes. Herpes simplex keratitis is the most common infectious cause of corneal blindness in high-income countries. Repeated episodes of keratitis cause progressive corneal scarring that reduces vision. Early treatment and long-term suppressive therapy reduce this risk substantially.

How do you get herpes in the eye?

Most commonly through autoinoculation — touching an active cold sore and then touching the eye. Less commonly through reactivation of HSV latent in the trigeminal nerve extending to the eye. Direct contact of the eye with infected genital secretions is a rare but documented route.

Is eye herpes contagious?

The virus causing it is contagious, but casual contact with someone who has eye herpes poses low risk. The main concern is autoinoculation from your own oral herpes to your eye — wash hands carefully and avoid touching eyes when you have an active cold sore.

Related: How is herpes spread? · Herpes window period · Living with herpes · Get tested today

This article is for informational purposes only and does not constitute medical advice. Eye symptoms require urgent ophthalmological evaluation.