What is Herpes eyes?
Infection. Depending on the location of herpes infection, the following types of lesions are distinguished: herpes dermatitis of the eyelids; herpetic conjunctivitis; herpetic epithelial keratitis (treelike) and its variants: vesicular, stellate, spotted, with stromal lesion, potato; herpetic keratitis stromal: discoid, herpetic corneal ulcer, herpetic keratouveitis (with ulceration, without ulceration), herpetic uveitis (without corneal damage); postherpetic trophic keratitis (epitheliopathy, bullous keratitis). Herpetic iridocyclitis, chorioretinitis, neuritis, episcleritis, and recurrent erosion are also possible.
Causes of Herpes Eye
The causative agent is herpes simplex virus (medium-sized filtering virus). It has dermatotropic, neurotropic and mesotropic effects. Multiple strains of the herpes simplex virus, differing in biological and antigenic properties, immunological activity and pathogenicity, have been identified.
Pathogenesis
The carrier of the virus is man. In large quantities, the virus is in the contents of the herpetic vesicles and in the saliva of the patient. Infection occurs by contact or airborne droplets. Gates of infection: skin, mucous membranes of the mouth, nose, nasopharynx, eyes, urinary tract. In the vascular tract, cornea, conjunctiva, the lacrimal gland, the virus also enters the hematogenous route. The virus in the body can be a long time in an inactive state. The development of the disease is promoted by other infections (flu, pneumonia), cooling, overheating, physical and mental trauma.
In the pathogenesis of the disease, inflammatory and dystrophic changes in eye tissues and secondary degenerative phenomena in peripheral nerves matter. Herpes infection can be a local manifestation of the disease (blepharoconjunctivitis, keratoconjunctivitis, aphthous stomatitis, vulvovaginitis, herpes skin of the eyelids, face).
Symptoms of Herpes Eye
Herpetic eyelid dermatitis. On the background of a slightly reddened skin of the face and eyelids appear transparent bubbles. Frequent chills, fever, headache. Sometimes the appearance of bubbles is preceded by a feeling of itching, burning, tension of the skin. The contents of the bubbles quickly become cloudy, they dry up with the formation of crusts, which after 1-2 weeks disappear, leaving no scars. Bubbles can be single or multiple, sometimes they are located in different parts of the skin.
Herpetic conjunctivitis is observed in 3 clinical forms: follicular, catarrhal, and vesicular-ulcerative. The follicular form is characterized by a long sluggish course, lack of microflora, often accompanied by a rash of herpes blisters on the skin of the eyelids and nose wings. The catarrhal form has a rapid onset and a shorter flow. When vesicular-ulcerative form on the conjunctiva rash of fresh herpetic vesicles and their subsequent reverse development without cicatricial changes of the mucous membrane is noted.
Herpetic keratitis. Common symptoms for herpetic keratitis are: a sharp decrease or complete lack of sensitivity of the cornea and the absence or late appearance of vascularization, as well as a tendency to relapse. The most characteristic form is tree keratitis. Bubbles in the epithelial layer pour along the nerve trunks. Merging and maligning, vesicles and infiltrates form a peculiar shape resembling a tree branch. Around this area, the surface of the cornea is usually swollen, as if “istika”. More often, ulceration spreads over the surface and into the stroma of the cornea; the iris may be involved in the process, iritis or iridocyclitis occurs. Often, tree keratitis occurs in the form of severe keratouveuita.
Stromal keratitis is always accompanied by a more or less pronounced lesion of the vascular tract (herpetic kerato-iridocyclitis). Characterized by torpid flow, recurrence, decreased corneal sensitivity, serous and serofibrinous iridocyclitis, often with large gray or whitish precipitates and massive deposits on the posterior surface of the cornea, hyperemia of the iris and often increased intraocular pressure. In discoid keratitis, intense infiltration of the corneal stroma in the middle and deep layers of the cornea in the form of a well-defined disc, usually located in the central optical zone, pronounced descemets, thickening of the cornea at the location of the main focus, and precipitates are noted. Often join iritis and iridocyclitis. In atypical forms of the disease, a displacement of the “disk” or its irregular shape is observed.
Herpetic ulcer of the cornea is characterized by a sluggish and long course. The ulcer is usually clean, without discharge, often does not cause pain. May be complicated by secondary infection.
Herpetic keratouveitis (uveakeratitis) is accompanied by changes in the vascular tract (anterior uveitis). Characterized by infiltrates in different layers of the cornea, ulceration, precipitates, newly formed vessels in the iris, exudate, deep folds of the Descemet’s membrane, often bullous keratoiridocyclitis with the appearance of blisters and erosions in the epithelium, increased intraocular pressure in the acute period of the disease. In the long run, deep and superficial vascularization of the cornea appears.
Herpetic uveitis without corneal damage is characterized by the presence of small centrally located precipitates and opacities in the vitreous body.
Recurrent herpetic lesion of the inner membranes of the eye can manifest as an isolated iridocyclitis, chorioretinitis, retinal perivasculitis, optic neuritis. Herpetic iridocyclitis is characterized by a prolonged sluggish course, the presence of precipitates in the center of the cornea, and extensive posterior synechia. In the vitreous body formed coarse fibers – strands, significantly reducing visual acuity. Complicated cataract and secondary glaucoma may also develop. Often the choroid, retina and optic nerve are involved in the pathological process. Frequent relapses.
Postherpetic trophic keratitis is characterized by thickening and unevenness of the cornea, a complete lack of sensitivity, elevation and roughness of the epithelium, the presence of periodically appearing and disappearing vesicles. The course of the disease is long, accompanied by a significant decrease in visual acuity.
Features of the clinical course of herpes in children. Characterized by acute onset, conjunctival edema, follicles, rash of herpes vesicles on the edge of the eyelids. Diffuse corneal edema or light superficial infiltrates in it. The disease is often preceded by flu, measles, scarlet fever and other infections. Herpes of the eye is often accompanied by lymphadenitis. In severe cases, an early and abundant vascularization of the cornea occurs, accompanied by inflammation of the uveal tract.
Diagnosing Herpes Eye
Given the polymorphism of the clinical picture, the diagnosis of herpetic diseases often presents significant difficulties. Herpetic keratitis is characterized by neuralgic trigeminal syndrome and decreased sensitivity of the cornea, skin of the forehead, tongue, and soft palate on the side of the sore eye. What matters is the persistent course of the process, often long and recurrent. Biomicroscopy reveals the characteristic form of lesions of the cornea (treelike, discoid keratitis, etc.). Diagnosis is facilitated by virus isolation from the epithelium of the affected cornea (especially in the early stages of the disease), virus cultivation on tissue cultures, cytological findings in the epithelium of the conjunctiva and cornea of patients (giant epithelial cells with a large number of nuclei, the presence of intracellular inclusions in conjunctival exudate – lymphocytes). In the acute period of herpetic disease, the method of immunofluorescence in scrapings of the conjunctival epithelium often reveals the antigen of the herpes simplex virus. The reaction of complement fixation is not always conclusive due to the fact that most people over 15 years old have neutralized antibodies in their blood. Anamnesis data (previous acute infections, cooling, eye microtraumas, etc.) are also important for diagnosis.
The differential diagnosis is carried out with adenoviral conjunctivitis and tuberculous iridocyclitis. The follicular form of herpetic conjunctivitis differs from adenoviral affection of the conjunctiva by a lesser severity of inflammatory events, a longer course and a tendency to relapse. In herpetic iridocyclitis, unlike tuberculosis precipitates are usually located in the central region of the cornea.
Herpes Eye Prevention
In case of post-primary herpes against the background of chronic latent infection, the main measures are aimed at preventing the recurrence of the disease. It is important to exclude hypothermia of the body, various colds, prolonged insolation followed by cooling, nervous stress, injuries of the conjunctiva and the cornea. During the epidemic of the flu, interferon and interferon preparations should be installed for prophylaxis to persons who have had herpes eyes. For the purpose of specific prevention of relapses, vaccination courses with herpes polyvaccine are used in the “cold” period, when there are no signs of exacerbation of the disease. The vaccination course includes 5 intradermal injections of 0.05-0.1 ml of the drug with an interval of 3 days. The course is carried out once in 6 months. With the development of a focal reaction, vaccination is continued using the dilution of the drug 1:10 – 1: 1000, increasing the number of intradermal injections by 2-3 times. An effective combination of the installation of interferonogen and herpes vaccine injection courses. Non-specific prophylaxis of primary herpes in young children is based on the prevention of transmission of the disease from other children or from adults suffering from herpes.