• How do I treat the pain from herpes of the eye?


    Question:

    How do I treat the pain from herpes of the eye? I have been using warm and cold compresses and pain medication. Are warm or cold compresses better?


    Answer:

    Herpetic eye infections can be particularly painful because the virus lives in the nerve fibers supplying the eye. Depending on the location of the infection (eyelid versus cornea versus inside the eye, etc.), the appropriate treatment for pain control varies. In general, you should always follow what your ophthalmologist recommends for anti-viral medications as this is the best way to reduce pain in a herpetic infection.

    Pain from a herpetic skin infection can be reduced with cool compresses to minimize the pain, inflammation, and swelling of the lid surface. Analgesics such as calamine lotion, capsaicin cream, and lidocaine skin patches, which are applied to the skin while avoiding the eye, can be effective in some cases. Warm compresses are occasionally recommended to remove oil deposits from the lid margin that can occur when the lids get inflamed.

    Depending on how severe a corneal epithelial (outermost layer of the cornea) herpetic infection is, your doctor may recommend lubricants such as artificial tears gel or ointment to help reduce the friction of the eyelid rubbing on the corneal surface. The pain from intraocular infections, unfortunately, can only be reduced by treating the virus. In select cases, topical steroids with anti-virals are used to reduce pain from inflammation. Since herpes family viruses live within nerves, and treatments can only suppress but not eliminate the virus, some patients develop long lasting pain even after the herpes flare has cleared. This is called post-herpetic neuralgia. The amount of pain can range from none to severe. Medications such as analgesics listed above, tricyclic antidepressants, gabapentin, or even narcotics are needed to treat this stubborn nerve-related, or neuropathic pain.


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