Eye herpes is a lesion of the eyeball or appendages of the eye caused by infection with the herpes simplex virus (HSV) 1, less often type 2. Clinical manifestations are represented by lacrimation, pain syndrome, photophobia, blepharospasm, the appearance of a “veil” or “fog” in front of the eyes. Diagnosis is based on the detection of HSV by fluorescent antibodies, the study of the nature of the lesion of the organ of vision using biomicroscopy, visometry, ultrasound of the eye, tonometry. Antiviral agents are used as etiotropic therapy. Additionally, NSAIDs, antibacterial drugs, reparants, antioxidants, glucocorticosteroids, immunostimulants are shown.
General information
Eye herpes occurs with a frequency of 1:8000. 25% of patients with primary lesion have relapses. After repeated cases of herpes, a recurrent course is noted in 75% of cases. The ratio of the frequency of occurrence of the primary and recurrent forms is 1:9. This pathology most often leads to corneal opacity and the development of corneal blindness. The prevalence of herpetic keratitis in the general structure of inflammatory diseases of the visual organ among adults is 20-57%. In childhood, this figure reaches 70-80%. Male and female individuals get sick with the same frequency. The disease is widespread everywhere.
Causes of eye herpes
The development of eye herpes is caused by infection with the herpes virus type 1. In rare cases, herpetic eye damage causes HSV type 2. The role of HSV type 6 in the occurrence of eye herpes has not been fully studied. The activation of a persistent virus in the body is facilitated by stress, traumatic injuries, infection, hypothermia, hyperinsolation. The high–risk group includes pregnant women with a history of herpes and people who have been treated with prostaglandins, glucocorticosteroids, and immunosuppressants. Corneal injury leads to deep erosion of herpetic origin.
Pathogenesis
The herpes virus more often affects the cornea. The nature of the development of secondary changes is determined by the viral load and the state of the immune system. It is proved that pathology often occurs against the background of cellular immunity deficiency. The probability of virus penetration increases with a decrease in the production of interferon, secretory antibodies by subepithelial lymphoid tissue. Pathological agents can enter the tissues of the eyeball exogenous, hematogenic or neurogenic way. With exogenous penetration, the virus multiplies directly in the thickness of the epithelial layer of the cornea. Prolonged course of cytopathic and degenerative-dystrophic processes leads to necrosis and rejection of corneal tissue.
In the case of superficial damage, a small defect is formed, which is further epithelized. This leads to the persistence of the virus in the trigeminal node and the membranes of the eye. Exposure to adverse factors causes activation of pathological agents. With deep damage to the stroma, direct cytopathic action provokes its destruction with the concomitant development of an inflammatory reaction. The role of antigenic mimicry in the attachment of cross-reacting antigens, which entail the activation of autoimmune reactions, is being studied.
Classification
In most cases, eye herpes is an acquired pathology. Isolated cases of intrauterine infection with the development of symptoms in newborns are described. In accordance with the clinical classification accepted in ophthalmology , the following forms of herpetic lesion are distinguished:
- Primary. Occurs during primary infection. Isolated eye damage is often characterized by the involvement of only the surface layers in the pathological process.
- Recurrent. Its development is due to the persistence of HSV in the body. Unlike the primary form, the recurrent course leads to unilateral damage.
- The front one. When the herpes virus affects the anterior segment of the eyes, conjunctivitis, blepharoconjunctivitis, keratitis and corneal erosion occur. Depending on the nature of the inflammation of the cornea, vesicular, tree-like, geographical and marginal variants of eye herpes are distinguished.
- Rear. Pathology of the posterior part of the eyes is represented by retinochorioiditis, chorioretinitis, optic nerve neuritis, acute retinal necrosis syndrome, uveitis, retinopathy.
Symptoms
The clinical picture of eye herpes is determined by the nature of the lesion of the structures of the eye. With herpetic conjunctivitis, patients note redness, swelling of the conjunctiva and eyelids. Mucous and purulent discharge are accompanied by burning and itching of the eyes. With the tree-like form of keratitis, patients complain of increased lacrimation, blepharospasm, photophobia. Pericorneal injection is combined with severe pain syndrome. The decrease in visual acuity is due to the localization of the lesion in the optical zone of the cornea. When the infection spreads to the anterior part of the vascular membrane of the eye, hyperemia, “floating opacities” in front of the eyes join the symptoms described above. Posterior uveitis is manifested by blurred vision, distortion of the visible image.
Herpetic iridocyclitis is characterized by a chronic progressive course. The symptoms of pathology include visual dysfunction, the appearance of “fog” or “shroud” in front of the eyes. The clinical picture of retrobulbar neuritis is dominated by complaints of severe pain in the eye socket with irradiation into the brow arches, frontal and temporal areas of the head. With herpetic myositis of the oculomotor muscles, patients note that the movements of the eyeballs are sharply hindered, accompanied by sharp soreness. In most patients, relapses are observed once a month and more often, which indicates a severe course of pathology. Patients report relapses associated with previous psychological stress, hypothermia, acute respiratory infections.
Complications
Severe course of herpetic keratitis is complicated by corneal opacity (16%) with further development of corneal blindness (5%). Often keratoiridocyclitis potentiates the occurrence of secondary ophthalmohypertension. In the stromal form of the disease with ulceration of the cornea, there is a high risk of inflammation of the membranes of the anterior part of the eyes (bacterial conjunctivitis, blepharoconjunctivitis, scleritis). In the chronic variant of pathology, pan- or endophthalmitis is a common complication. Secondary cataract is diagnosed in 12% of patients. The probability of glaucoma is 3%.
Diagnostics
The diagnosis is based on the collection of anamnesis of the disease, the results of laboratory and instrumental research methods. Herpes virus can be detected by using the method of fluorescent antibodies. A biopsy of the orbital conjunctiva serves as a material for diagnosis. The complex of ophthalmological examination includes:
- Biomicroscopy of the eye. With tree-like keratitis, small bubble-like defects are visualized, which after opening lead to the formation of erosion. The edges of the affected area are raised, edematous. With a progressive course, the formation of perilimbal infiltrates is noted, which are pathognomonic for the geographical variant.
- Non-contact tonometry. In the posterior form of pathology, there is a persistent increase in IOP caused by the production of serous or serous-fibrinous exudate.
- Ultrasound of the eyes. Ultrasound examination makes it possible to identify posterior precipitates, signs of damage to the posterior parts of the uveal tract with clouding of optical media.
- Gonioscopy. Allows you to visualize anterior synechiae, determine the presence of exudate in the anterior chamber with anterior uveitis of herpetic genesis.
- Visometry. Visual dysfunction is observed only when defects spread to the optical center of the cornea.
- Ophthalmoscopy. Examination of the fundus reveals secondary changes in the retina and optic disc in the form of swelling and local foci of hemorrhage.
Before the appointment of immunotherapy, it is indicated to conduct an immunological study with the determination of T- and B-lymphocytes in the peripheral blood. Differential diagnosis of the posterior form is carried out with anterior ischemic neuropathy, central serous retinopathy. It is possible to suspect the herpetic genesis of pathology in the case of recurrent herpes of a different localization in the anamnesis preceding the visual symptoms of viral diseases of the respiratory tract.
Treatment of eye herpes
The main therapeutic measures are carried out by an ophthalmologist, aimed at suppressing the replication of virions and increasing the overall resistance of the body. Timely treatment allows to avoid the development of irreversible changes on the part of the membranes of the eyeball. In the treatment of eye herpes, the following is used:
- Chemotherapy with antiviral agents. With a superficial or stromal form of the disease with ulceration, local application of an eye ointment, which includes acyclovir, and instillation of concentrated interferon is indicated.
- Immunotherapy. Immunostimulants are used in the chronic course of herpes infection, frequent relapses, concomitant chronic diseases. Patients are shown the use of a synthetic agent based on glucosaminyl muralgildipeptide.
- Dexpanthenol. It is prescribed in the form of a gel with a superficial form in order to regenerate the cornea. Sometimes instillations of reparants – taurine, sulfated glycosaminoglycans are recommended.
- Antioxidants. They are used to potentiate the therapeutic effect of reparants. Instillations of methylethylpyridinol are shown 3 times a day.
- Antibacterial therapy. Antibiotics are prescribed for necrotizing course of eye herpes, signs of bacterial complications.
- Glucocorticosteroids. They are used at the end of corneal epithelization or in the subacute stage, provided that the shell is actively epithelized. Pharmaceuticals are used topically or injected parabulbar. Contraindicated in the acute phase of the inflammatory process in the presence of signs of ulceration of the cornea.
- Antihypertensive agents. This group of drugs is indicated with an increase in intraocular pressure or objective signs of swelling of the membranes of the eye.
With a prolonged or complicated course of pathology, in addition to the main treatment, nonsteroidal anti-inflammatory drugs, desensitizing drugs, vitamins, antiseptics are used. The need for their use is associated with the participation in the pathological process of not only infectious, but also allergic and autoimmune components. To increase the effect of antiviral therapy, drugs are administered using physiotherapeutic techniques – magneto- and phonophoresis. During clinical remission, surgical correction of secondary complications is indicated.
Prognosis and prevention
The outcome of the disease is determined by the features of the eye lesion. In severe cases, there is a high risk of irreversible vision loss. Timely treatment allows you to achieve complete remission. In order to prevent relapses during the period of “imaginary well-being”, the introduction of a herpetic multivaccine under the control of immunological parameters is recommended. Non-specific preventive measures are based on the treatment of herpes of other localizations, prevention of contact with patients with herpes infection, increasing the overall reactivity and resistance of the body.
