Herpes on the Eye and Eyelids: Symptoms and Why It Is Dangerous

Herpes simplex virus can affect the eyelids, conjunctiva, and cornea, and herpetic keratitis is one of the common causes of corneal blindness in developing countries. Primary infection more often manifests as vesicles on the eyelids and redness of the conjunctiva, and when the cornea is affected, there can be serious consequences for vision.

What is ocular herpes (ophthalmic herpes)

Ophthalmic herpes is an eye infection caused by herpes simplex virus. Herpes is of two types: HSV-1 more often causes rashes around the mouth and on the face, HSV-2 causes genital herpes. Other herpetic infections can affect the eyes, skin, and other parts of the body. The virus is transmitted through direct contact and remains in the body forever: some people have no symptoms, while others develop vesicles at the site where the virus entered.

Herpetic keratitis is caused by herpes viruses types 1, 2, and 3 (zoster). It is estimated that one third of the world's population suffers from recurrent infections, and the global prevalence of herpetic keratitis is about 1.5 million new cases per year, including 40,000 cases of severe visual impairment or blindness in one eye.

Herpes on the eyelids, under the eye, and on the eyebrow: how it manifests

Primary infection more often looks like blepharoconjunctivitis — inflammation of the eyelids and conjunctiva, which heals without scarring. Symptoms: vesicles on the eyelids, redness of the conjunctiva, lacrimation, eye pain. The cornea is rarely affected in primary infection.

Herpes on the skin of the face begins with tingling, itching, or burning, and after 48 hours one or more painful vesicles appear, which then rupture and become covered with a crust. Rashes near the eye, under the eye, or on the eyebrow may be a manifestation of herpes on the skin of the face, but other causes are also possible — for example, a pimple, furuncle, or impetigo. The virus can spread to other parts of the body, so in case of doubt and with weakened immunity, a doctor's consultation is needed.

What herpes on the eye looks like

On the skin of the eyelids, small fluid-filled vesicles are visible, then crusts. On the eye, the changes are different: on examination with a slit lamp after staining with a fluorescent dye, linearly branching corneal ulcers are visible — the so-called dendritic ulcer. In stromal keratitis, disc-shaped corneal edema appears.

Symptoms of herpes of the eye

In epithelial keratitis, patients complain of a foreign body sensation, sensitivity to light, redness of the eyes, and blurred vision. In stromal keratitis, corneal sensitivity is reduced, there is a foreign body sensation, increased intraocular pressure, watery vesicles. With subsequent exacerbations, corneal sensitivity decreases.

• Tingling, itching, or burning on the eyelid 1–2 days before the rash
• Painful vesicles on the skin of the eyelids, under the eye, or on the eyebrow
• Redness of the eye, lacrimation, photophobia
• Foreign body sensation and blurred vision

Complications: why herpes of the eye is dangerous

Long-term corneal edema in stromal keratitis leads to constant scar formation — the main cause of vision loss associated with herpes simplex virus. In people with immunodeficiency or taking corticosteroids, ulcers can become large (geographic ulcers). The virus is especially dangerous for newborns and people with weakened immunity.

Diagnosis and when to see a doctor urgently

The diagnosis of herpetic keratitis is usually made by an ophthalmologist based on examination of the eye. Laboratory tests are rarely needed — in stromal keratitis there is no live virus. In complex cases, tests for viral DNA and antibodies are used; DNA testing is rapid, sensitive, and specific, but expensive.

You should see a doctor if the rash has not begun to heal within 10 days, it is very large or painful, you are unsure about the diagnosis, and also with weakened immunity — for example, due to chemotherapy or diabetes.

A rash on the eyelid by itself is not a reason to call an ambulance. Call 103 or 112 for life-threatening conditions — signs of stroke or heart attack, severe injury.

This material is for reference: only a doctor can make a diagnosis and assess the risk to vision after an examination.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer