Viral infections and the eye

 Vaccinations can prevent shingles but not other eye viruses. Photo Cape May

Have you wondered if you can get infected with H1N1 or “swine flu” virus by rubbing your eyes? Or whether you should be worried about viral infection if your eyes become red, watery, and irritated?

H1N1 virus is typically transmitted by inhaling aerosolized cough or sneeze particles from infected individuals. But, it is also transmitted by touching infected surface and then touching mucous membranes, such as the mouth and the eyes. So, you can get H1N1 by rubbing your eyes.

The H1N1 virus, however, causes only mild eye redness, tearing, and irritation. Its main effects are on the respiratory system, resulting in flu-like symptoms. If eyes become significantly red, swollen, teary, itchy, and irritated, other viruses should be considered.

Common viral eye infections

• Adenovirus – is the most common viral eye infection and the most common cause of “pink eye” in adults and kids. It can be acquired by touching a surface covered in secretions containing viral particles and then rubbing the eyes. This virus is highly contagious. It is transmitted easily among people living or working in close knit quarters – like nursing homes, kindergartens, schools, for example. Eyelid swelling can be significant. Sometimes, vision can be impaired.
• Herpes Simplex Virus – on the eye is same type of herpes virus that causes cold sores, Herpes Simplex 1 (HSV1). In contrast, genital herpes are causes by HSV2. While a small portion of the population carries HSV2, almost everyone is a carrier of HSV1. Not everyone has breakouts, however. Breakouts are usually in the form of cold sores. But, sometimes, the breakouts can be on the eye lids or on the cornea. Anecdotally, stress, sunlight, cold, and periods have been associated with herpes breakouts. Scientific studies, such as the Herpetic Eye Disease Study (HEDS), couldn’t find any factors that precipitated breakouts, other than HIV positive status. HIV testing needs to be done in patients experiencing frequent herpes breakouts.
• Herpes Zoster Virus (shingles) – typically happens in older patients with history of chicken pox. Shingles can cause painful rash on eyelids and forehead. If it activates inside the eye, it can cause decreased vision and sometimes, even loss of vision.
• Molluscum – is a wart like bump on the lid that can result in a chronic pink eye. If you have a pink eye that lasts for weeks, a visit to an eye doctor may uncover the tiny bump that’s causing the problem.

Treatment of viral eye infections

• Adenovirus – treatment includes cold artificial tears, cold compresses and, sometimes, antibiotic eye drops to prevent bacterial infection. Steroid eye drops can be used sometimes as well depending on the severity of eye swelling and corneal inflammation. Steroids need to be tapered slowly. If they are discontinued abruptly, corneal inflammation may come back and be difficult to treat. The pink eye typically clears within several weeks. New treatment methods for “pink eye” caused by Adenovirus include betadine applied at the doctor’s office. This treatment may help infection clear faster.
• Herpes Simplex Virus – treatment includes anti-viral drops or pills such as Acyclovir (Zovirax), Famcyclovir (Famvir), and Valcyclovir (Valtrex), for example, depending on the severity of the infection. Of all the pills, Valtrex needs to be taken the fewest number of times per day (only twice a day). Sometimes a steroid eye drop is given. The treatment should be done under close doctor’s supervision.
• Herpes Zoster Virus (shingles) – treatment includes oral anti-virals and sometimes steroid eye drops. Oral steroids and other medications can be taken to decrease intensity and even prevent painful skin condition called post-herpetic neuralgia which can last for months after the skin rash clears. The treatment should be done under close doctor’s supervision.
• Molluscum – can be frozen or excised by the doctor. This will result in clearing of the pink eye.

Do’s and don’ts of preventing viral eye infection

• Do wash your hands with soap and water before touching your face.
• Do wash your hands after touching surfaces in public places such as coffee shops, gyms, doctor’s offices, movie theatres, public transportation, schools, and kindergartens, for example.
• Do take time off work and school if you have viral infection to prevent spread to other people.
• Do consider herpes zoster vaccination if you are 60 years old and older to prevent shingles, not just on the eye, but on other parts of the body as well. FDA trials found it to be effective in preventing shingles in older adults. No vaccines currently exist for other types of viral eye infections.
• Don’t share towels or utensils with infected individuals.

Pacific Vision Institute www.pacificvision.org
Zostavax www.zostavax.com
American Academy of Ophthalmology www.aao.org
Center for Disease Control www.cdc.gov