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Suggest Treatment For Recurrent Herpes Simplex Leshions Around Eye
Question: So i unfortunatly have hsv-1 and i have had this for 4 years now. I was first exposed to it when i was 24 years old and i am now 28 year old male living in the USA. I got it from kissing a girl who at the time had an active sore on her lip. Since being exposed i have anywhere from 2-6 outbreaks a year on my lip which is where my first outbreak occured. So far i have never had an outbreak anywhere else on my body besides my lip. My question is about it moving or spreading to my eye via the trigemaniel ganglion by way of the ophthalmic of the fitfh cranial nerve? Or any nerve for that matter and i end up someday with hsv ocular or hsv keratits or active outbreaks around my eye? Is that something i should worry about or even be thinking about? Is it a common occurance or rare? Just a worry and fear i have that has caused me some stress lately.
Brief Answer:
Oral herpes will not spread to eyes via nerves.
Detailed Answer:
Hello
Welcome to Health care Magic.
I am Dr. DADAPEER K, an Ophthalmologist and I answer health problems related to eye.
I reviewed your history and I can understand your concern.
It seems from the history that you are having recurrent herpes simplex lesions affecting the lip. This is called as herpes labialis or cold sores. This is caused by infection by herpes simplex virus and as you know once the infection is acquired it remains latent in the nerves and it comes back again to involve the original site of infection whenever there is fever, cold, stress....
But usually it will not travel to other sites and fresh infection, hence no need to worry.
However the oral herpes will be contagious in the stage of vesicles and touching the vesicles and rubbing the eyes or other sites of mucous membranes can result in spread of the infection.
Hence during the active stage of oral herpes with lesions, you should not touch the lesions and rub the eyes.
The treatment with antiviral drugs during the periods of active lesions will help in preventing the recurrences. I usually treat my patients with oral tablets of Acycloivr 200-400 mg during the active periods of active herpes infection.
Hence I advice you not to worry as usually oral herpes will not spread to eyes via the nerves and if at all it occurs it occurs because of direct transfer during the active infective stage by touching the lesions and rubbing the eyes. Hence you need to wash the eyes thoroughly after the touching the lesions and preferably can take treatment with oral acyclovir or other alternative antiviral drugs.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
Oral herpes will not spread to eyes via nerves.
Detailed Answer:
Hello
Welcome to Health care Magic.
I am Dr. DADAPEER K, an Ophthalmologist and I answer health problems related to eye.
I reviewed your history and I can understand your concern.
It seems from the history that you are having recurrent herpes simplex lesions affecting the lip. This is called as herpes labialis or cold sores. This is caused by infection by herpes simplex virus and as you know once the infection is acquired it remains latent in the nerves and it comes back again to involve the original site of infection whenever there is fever, cold, stress....
But usually it will not travel to other sites and fresh infection, hence no need to worry.
However the oral herpes will be contagious in the stage of vesicles and touching the vesicles and rubbing the eyes or other sites of mucous membranes can result in spread of the infection.
Hence during the active stage of oral herpes with lesions, you should not touch the lesions and rub the eyes.
The treatment with antiviral drugs during the periods of active lesions will help in preventing the recurrences. I usually treat my patients with oral tablets of Acycloivr 200-400 mg during the active periods of active herpes infection.
Hence I advice you not to worry as usually oral herpes will not spread to eyes via the nerves and if at all it occurs it occurs because of direct transfer during the active infective stage by touching the lesions and rubbing the eyes. Hence you need to wash the eyes thoroughly after the touching the lesions and preferably can take treatment with oral acyclovir or other alternative antiviral drugs.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Really?? I didnt know that honestly. Ive been on google alot, bad idea i know, but ive just been reading upon it and it has been scaring me the fear that it can spread to my eyes via the nerves.
Brief Answer:
No need to worry, this will not occur normally.
Detailed Answer:
Hello
Thank you for the follow up question.
Ya the recurrent herpes will not involve the new sites and hence no need to worry.
However in case of immunodeficiency, it can become generalized and involve the new sites. Hence until unless there is immunodeficiency no need to worry. But you have to take precautions to prevent the spread of the infection to eyes by direct rubbing the eyes after touching the infected sores.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
No need to worry, this will not occur normally.
Detailed Answer:
Hello
Thank you for the follow up question.
Ya the recurrent herpes will not involve the new sites and hence no need to worry.
However in case of immunodeficiency, it can become generalized and involve the new sites. Hence until unless there is immunodeficiency no need to worry. But you have to take precautions to prevent the spread of the infection to eyes by direct rubbing the eyes after touching the infected sores.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I knew that, actually we were talking earlier today about that caruncle that was slightly inflammed and i sent you all those pictures? You just finished answering that question a few minutes ago. I actually 4 days ago accidently touched a open and leaking active cold sore then i think i touched my eye immediatly afterward. Would that caruncle inflammed and that i sent pictures of that you looked at be hsv starting in my eye? Or is that something totally different and unrelated?
Brief Answer:
Your carunculitis is not related to hereps.
Detailed Answer:
Hello
Thank you for the follow up question.
The photos and the pictures you have sent does not look like ocular herpes. The herpes of the eye presents with vesicular lesions of the eyelid, conjunctivitis and in sever cases presents with typical dendritic ulcer of the cornea.
None of the above problems were seen and hence I think your caruncle inflammation is a different entity and it is not related to herpes infection.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
Your carunculitis is not related to hereps.
Detailed Answer:
Hello
Thank you for the follow up question.
The photos and the pictures you have sent does not look like ocular herpes. The herpes of the eye presents with vesicular lesions of the eyelid, conjunctivitis and in sever cases presents with typical dendritic ulcer of the cornea.
None of the above problems were seen and hence I think your caruncle inflammation is a different entity and it is not related to herpes infection.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Well lets say that i accidently did spread hsv-1 to my eye, when would symptoms show up? Like when would i know for sure that i have done that? Ive seen anywhere from 2 days to 3 days to 5 days to 7 days all the way up to 30 days? Is there a set amount of time that say once i make it 5 days for example and there are no symptoms then i can consider myself safe and at no risk?
Brief Answer:
Infection depends on the incubation period,2-5days
Detailed Answer:
Hello
Thank you for the follow up question.
The usual incubation period of the herpes infections is 2-5 days. If there are no lesions after 5-7 days, then it rules out herpes infection.
Hence if you are not having any lesions even after 5-7 days then you can consider that there is no infection.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
Infection depends on the incubation period,2-5days
Detailed Answer:
Hello
Thank you for the follow up question.
The usual incubation period of the herpes infections is 2-5 days. If there are no lesions after 5-7 days, then it rules out herpes infection.
Hence if you are not having any lesions even after 5-7 days then you can consider that there is no infection.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Well i think THINK i touched my eye and surrounding area of my eye tuesday morning after touching an active and leaking cold sore on my lip and this is now late saturday night. So if by tuesday morning i dont have any symptoms then i consider myself safe and risk free? What is the chances with one touch with an infected finger to my eye that i will have spread it?
Brief Answer:
The chances are about 20-30%.
Detailed Answer:
Hello
Thank you for the follow up question.
Yes if even after 5-7 days if you do not have any symptoms like vesicles over the skin.... and other symptoms as I mentioned previously, it is most likely that there is no infection.
The chances of spread of infection from oral lesions to the eye or other part depends on the presence of virus in the discharge and the stage of the disease. As in the later phase the antibodies will appear and they will prevent the spread of infection to eye or other parts.
The literature quotes the chances between 20-30% of spreading the infection by fingers.
In my practice I see rarely may be 1 in every 10 patients having herpes at two different sites with one site being eye involvement.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
The chances are about 20-30%.
Detailed Answer:
Hello
Thank you for the follow up question.
Yes if even after 5-7 days if you do not have any symptoms like vesicles over the skin.... and other symptoms as I mentioned previously, it is most likely that there is no infection.
The chances of spread of infection from oral lesions to the eye or other part depends on the presence of virus in the discharge and the stage of the disease. As in the later phase the antibodies will appear and they will prevent the spread of infection to eye or other parts.
The literature quotes the chances between 20-30% of spreading the infection by fingers.
In my practice I see rarely may be 1 in every 10 patients having herpes at two different sites with one site being eye involvement.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for the info. The blisters had just formed and i scratched across them and poped them open unknowingly and touched my eye right after with my contaminated finger i think.
Brief Answer:
Observe the skin of the lids for another 2 days.
Detailed Answer:
Hello
Thank you for the follow up question.
The herpetic lesions usually remain infective for the 2-5 days. Since the risk of spread of infection from oral lesions via fingers is only 20-30% and you are not having any lesions now , no need to worry.
If you do not develop any lesions by 5-7 days, then it indicates that there is no infection.
Hence I advice you to follow up with close observation and do get back to me for further questions.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
Observe the skin of the lids for another 2 days.
Detailed Answer:
Hello
Thank you for the follow up question.
The herpetic lesions usually remain infective for the 2-5 days. Since the risk of spread of infection from oral lesions via fingers is only 20-30% and you are not having any lesions now , no need to worry.
If you do not develop any lesions by 5-7 days, then it indicates that there is no infection.
Hence I advice you to follow up with close observation and do get back to me for further questions.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
So im probably ok, but ill know 100% for sure in another 3-4 days since that is when i accidently touched my eye. Which means im gonna be stressed to the XXXXXXX and living in fear untill then as when this happened the outbreak had just appeared on my lip.
Brief Answer:
The eye is normal and no need to worry.
Detailed Answer:
Hello
Thank you for the follow up question.
Since it is already 5 days the chance of infection of the eye is very remote, hence no need to be worried or under stress. Your eye and the skin of the surrounding eyelids appears fine and normal. No need to worry as ocular herpes will give a separate picture and it will show vesicles in the surrounding eyelids.
Hence no need to worry, I told you to wait for 2 days to rule it out 100% as it was tuesday last week and by this tuesday it will be more than 7 days which is more than the incubation period.
Hence I advice you not to worry or be stressed as I told you in my practice rarely I come across coexisting infections simultaneously and the reason for this is the presence of antibodies which will not allow the second infection.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
The eye is normal and no need to worry.
Detailed Answer:
Hello
Thank you for the follow up question.
Since it is already 5 days the chance of infection of the eye is very remote, hence no need to be worried or under stress. Your eye and the skin of the surrounding eyelids appears fine and normal. No need to worry as ocular herpes will give a separate picture and it will show vesicles in the surrounding eyelids.
Hence no need to worry, I told you to wait for 2 days to rule it out 100% as it was tuesday last week and by this tuesday it will be more than 7 days which is more than the incubation period.
Hence I advice you not to worry or be stressed as I told you in my practice rarely I come across coexisting infections simultaneously and the reason for this is the presence of antibodies which will not allow the second infection.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
This is now sunday morning here where i am and it happened tuesday morning. Heres some updated pictures of my eye and caruncle both.
Brief Answer:
No photos are available.
Detailed Answer:
Hello
Thank you for the follow up question.
I am sorry to inform that there are no updated photos available with this question. Do attach the photos and if you have any problem do contact our technical team.
But there were few updated photos for the other question which you had asked and they were normal and there was no sign of herpes infection. Hence no need to worry.
Do write back to me for further questions.
Thank you
With regards
No photos are available.
Detailed Answer:
Hello
Thank you for the follow up question.
I am sorry to inform that there are no updated photos available with this question. Do attach the photos and if you have any problem do contact our technical team.
But there were few updated photos for the other question which you had asked and they were normal and there was no sign of herpes infection. Hence no need to worry.
Do write back to me for further questions.
Thank you
With regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sorry i hit the wrong button before. Took these this morning 5 days after touching my eye. And 24 hours after yesterdays photos
Brief Answer:
The eye is normal, no need to worry.
Detailed Answer:
Hello
Thank you for the follow up question.
I saw the photo attached with the question.
It is normal and there are no signs of any lesions of herpes infection.
Hence no need to worry and since it is 5 days the chances of infection are almost nil and no need to worry.
You probably had a mild carunculitis and no need to worry also as even it has also resolved.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
The eye is normal, no need to worry.
Detailed Answer:
Hello
Thank you for the follow up question.
I saw the photo attached with the question.
It is normal and there are no signs of any lesions of herpes infection.
Hence no need to worry and since it is 5 days the chances of infection are almost nil and no need to worry.
You probably had a mild carunculitis and no need to worry also as even it has also resolved.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Theres a few extra pictures that didnt go through earlier? It still looks a little swollen and inflammed to me. Especially when i pull my bottom lid down but idk. Theres still a slight itch and a bit of that feeling like theres something in the corner of my eye. Now about carunculitis, im 28 years old and never had this before or even heard of it. What caused this to happen to me? Am i at risk now for it to happen again since it has happened once now? Does it cause any other risk to future problems with my eye or caruncle? Theres extra pictures for you to check both the caruncle and for hsv.6
Brief Answer:
The photos are normal, no need to worry.
Detailed Answer:
Hello
Thank you for the follow up question.
I saw the photos attached with the question.
These photos are normal and there are no signs of herpes infection of the skin of the eyelids or of the conjunctiva. Hence no need to worry.
Coming to carunculitis, it is a non specific inflammation of the caruncle. The common causes are allergies, infection by bacteria.....
The causes and treatment are simple to that of conjunctivitis. Carunculitis is very common in occurrence and not diagnosed as a separate entity as it is often diagnosed as conjunctivitis and treated like conjunctivitis.
This is benign problem and will not cause any problems.
The caruncle in your photo is slightly red and this will resolve slowly. If you are having symptoms of irritation of the caruncle then you can use anti-inflammatory eye drops as I had advised already.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
The photos are normal, no need to worry.
Detailed Answer:
Hello
Thank you for the follow up question.
I saw the photos attached with the question.
These photos are normal and there are no signs of herpes infection of the skin of the eyelids or of the conjunctiva. Hence no need to worry.
Coming to carunculitis, it is a non specific inflammation of the caruncle. The common causes are allergies, infection by bacteria.....
The causes and treatment are simple to that of conjunctivitis. Carunculitis is very common in occurrence and not diagnosed as a separate entity as it is often diagnosed as conjunctivitis and treated like conjunctivitis.
This is benign problem and will not cause any problems.
The caruncle in your photo is slightly red and this will resolve slowly. If you are having symptoms of irritation of the caruncle then you can use anti-inflammatory eye drops as I had advised already.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello i thought i would post some more pictures for you to check out for me? Just to make sure everything is ok. Also in a couple of the pictures on my bottom eyelid on the inside you can see a tiny white spot i was curious what it is and if it is cause for concern?? You can see it in a few a the pictures im gonna upload today for you. Its on my bottom lid on the inside.
Brief Answer:
These photos are normal.
Detailed Answer:
Hello
Thank you for the follow up question.
I saw the photos attached with the question.
These photos are normal and no need to worry.
The white spots you are pointing are conjunctival concretions. These are nothing but accumulations of thick conjunctival secretions. These are commonly seen and no treatment is required. If they are associated with symptoms like irritation, discomfort, foreign body sensation... they needs to be removed. This is done by your ophthalmologist by using a simple hypodermic needle.
In your case these appear very small and tiny and no treatment is required.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
These photos are normal.
Detailed Answer:
Hello
Thank you for the follow up question.
I saw the photos attached with the question.
These photos are normal and no need to worry.
The white spots you are pointing are conjunctival concretions. These are nothing but accumulations of thick conjunctival secretions. These are commonly seen and no treatment is required. If they are associated with symptoms like irritation, discomfort, foreign body sensation... they needs to be removed. This is done by your ophthalmologist by using a simple hypodermic needle.
In your case these appear very small and tiny and no treatment is required.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Theres just one more picture to show it kinda zoomed out to get a better picture of it. I cant tell if its raised or not and of course it doesnt wipe off. My eye is somewhat irritated feeling but idk if thats cause of my caruncle or cause of that white spot. Theres 1 more picture added. My fear was it was the start of an hsv outbreak.
Brief Answer:
The white spot is concretion.
Detailed Answer:
Hello
Thank you for the follow up question.
I saw the photo attached with the question. It is concretion and no need to worry about it.
It is not herpes infection and no need to worry.
The concretion is very small and it is unlikely to be the cause for your irritation.
The irritation is probably because of carunculitis and this will resolve no need to worry.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
The white spot is concretion.
Detailed Answer:
Hello
Thank you for the follow up question.
I saw the photo attached with the question. It is concretion and no need to worry about it.
It is not herpes infection and no need to worry.
The concretion is very small and it is unlikely to be the cause for your irritation.
The irritation is probably because of carunculitis and this will resolve no need to worry.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello doctor, so today i decided to make an in person appointment with an opthalmologist just to let someone see me in person for peace of mind. He checked my eyes with multiple devices and then numbed them and checked them with something else and also did a pressure check on it. From what he saw he prescribed me drops called Neomycin/polymyxin/dexamethasone - ophthalmic drops. I was wondering if you were familiar with those drops and ok for me to use giving that i have the hsv virus in my body? As far as hsv and my risk for it going to my eye he did not reassure me or give me any peace of mind or help me at all with my worries. He said it could travel there even without my spreading it by my finger but it could activate on its own there through my nerves i guess and i cant do anything to stop it or prevent it. He said it is basically just a "luck of the draw" type thing and can happen to anyone with hsv at anytime. Which has me dissapointed and worried. He talked to me like hsv randomly activating in the eye is a common thing. About the eye drop he prescribed me are they safe for me to use??? He called these steroid drops and i have read multiple times on the internet that steroid drops run the risk of causing hsv to activate in the eye and can cause an outbreak. Ive read they weaken the immunity of the eye and can cause hsv to travel there and activate. Im scared and worried to use these drops. I dont know what to do doctor.
Brief Answer:
You can use steroid eye drops.
Detailed Answer:
Hello
Welcome to Health care magic.
Thank you for the follow up question.
I reviewed your history. Regarding the use and need of Neomycin-Polymixin-Dexamethasone eye drops, it is a antibiotic steroid eye drop. As you rightly pointed steroid eye drops should be used with care because of side effects associated with the steroids.
However presence of herpes virus infection somewhere else or presence of herpes infection in the past is not a known contraindication hence you can use them. However with the herpes infection in the eye either present or past these have to used carefully or better to be avoided if other alternative eye drops are available.
You can use these eye drops as I find no harm, but you need to use them for the prescribed period only and if required for more than one week they have to be tapered. If you are very much worried to use them you can go for the non steroidal anti-inflammatory eye drops which are very safe as compared to steroids.
Coming to the risk of herpes infection reaching the eyes from the oral infection, the chances are very minimal and no need to worry. As I already mentioned I see rarely anybody having simultaneous herpes labialis and herpes of the eyes. Hence no need to worry about the risk of herpes infection of the eyes.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
You can use steroid eye drops.
Detailed Answer:
Hello
Welcome to Health care magic.
Thank you for the follow up question.
I reviewed your history. Regarding the use and need of Neomycin-Polymixin-Dexamethasone eye drops, it is a antibiotic steroid eye drop. As you rightly pointed steroid eye drops should be used with care because of side effects associated with the steroids.
However presence of herpes virus infection somewhere else or presence of herpes infection in the past is not a known contraindication hence you can use them. However with the herpes infection in the eye either present or past these have to used carefully or better to be avoided if other alternative eye drops are available.
You can use these eye drops as I find no harm, but you need to use them for the prescribed period only and if required for more than one week they have to be tapered. If you are very much worried to use them you can go for the non steroidal anti-inflammatory eye drops which are very safe as compared to steroids.
Coming to the risk of herpes infection reaching the eyes from the oral infection, the chances are very minimal and no need to worry. As I already mentioned I see rarely anybody having simultaneous herpes labialis and herpes of the eyes. Hence no need to worry about the risk of herpes infection of the eyes.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
Above answer was peer-reviewed by :
Dr. Shanthi.E
My only worry was the warning sheet that came with the eye drops said that if you have a history of herpes simplex virus that you should not use these steroid type drops. Now is that warning refering to everyone who has a history of herpes outbreaks or just to those who have a history of herpes outbreaks in there eyes?
Brief Answer:
Steroid eyedrops should be used carefully in previous herpes eye infection.
Detailed Answer:
Hello
Welcome to Health care magic.
Thank you for the follow up question.
Yes you are right is worrying by reading the warning sheet. I will try to clear the doubt, steroid eye drops should be used carefully in people with previous history of herpes eye infection and this usually does not applies to the herpes infection elsewhere in the body.
The steroid eye drops usually will not affect the herpes infection elsewhere in the body, hence you can use them no need to worry.
But if you are still worried then you can use the more safer and almost equally effective non steroidal eye drops like ketorolac or flurbiprofen as I had mentioned previously.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
Steroid eyedrops should be used carefully in previous herpes eye infection.
Detailed Answer:
Hello
Welcome to Health care magic.
Thank you for the follow up question.
Yes you are right is worrying by reading the warning sheet. I will try to clear the doubt, steroid eye drops should be used carefully in people with previous history of herpes eye infection and this usually does not applies to the herpes infection elsewhere in the body.
The steroid eye drops usually will not affect the herpes infection elsewhere in the body, hence you can use them no need to worry.
But if you are still worried then you can use the more safer and almost equally effective non steroidal eye drops like ketorolac or flurbiprofen as I had mentioned previously.
Hope the information is helpful to you.
Do write back to me for further questions.
Thank you
With regards
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
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