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Ophthalmology Management

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An Overview of Viruses of the Eye

Current and emerging infectious diseases must remain on our radar

By: JAI G. PAREKH, MD, MBA, FAAO
Ophthalmology Management August 13, 2024

This article was originally published in a sponsored newsletter.

Many viruses can cause eye disease. While most people are familiar with conjunctivitis (more commonly known as “pink eye”), other virus families also affect the eyes. While they are not always given the urgent attention necessary, viral infections that impact ocular tissue can have serious and even vision-threatening complications.

When patients present with eye symptoms, it is imperative that they receive the proper diagnosis and begin prompt treatment. In this article, we will explore an overview of ocular viruses, including common presenting symptoms of these conditions.

Herpes Family Viruses

Most people associate herpes simplex viruses (HSV) with the painful cold sores it causes, but two strains of HSV (HSV-1 and HSV-2) can also cause eye infections. Also known as herpes eye disease or ocular herpes, patients might present with symptoms such as eye pain, redness, swelling, blurry vision and sensitivity to light. If not treated, herpes eye disease can lead to corneal scarring, elevated pressure and blindness. The varicella zoster virus, which is responsible for chickenpox and shingles, can also spread to the eyes.1

Adenovirus Family

Adenovirus is the most common cause of infectious conjunctivitis and is probably the most well-known eye virus.2,3 It is highly contagious and can spread rapidly in pediatric populations. Patients with adenoviral conjunctivitis may present with redness, inflammation, watery discharge, blurry vision and a painful preauricular lymph node. It may be necessary to distinguish adenoviral conjunctivitis from bacterial acute conjunctivitis. Bacterial conjunctivitis is more common in older children and adults and may not include all the aforementioned symptoms. It is, however, likely to present with mucopurulent discharge.4

Zika Virus Infections

Zika virus has been increasingly detected and reported in new regions, including the United States.5 Though significantly less common, it is worth noting that the Zika virus can also lead to ophthalmologic manifestations including chorioretinal scarring and focal pigmentary changes.6 A study out of the University of Missouri School of Medicine also found that Zika-infected mice developed increased intraocular pressure and optic nerve damage.5

Covid Virus Infections

Both pediatric and adult patients have reported conjunctivitis ahead of or concurrently with a Covid diagnosis.7 Because the immune system is compromised during Covid, patients might be more susceptible to these infections. Research is ongoing to explore the retinal manifestations of COVID especially in susceptible patients.2

The Evolution of Viruses and Ocular Manifestations

Emerging infectious diseases must remain on our radar as we closely watch how they might impact ocular health. Even now as we study the ocular manifestations of Covid and Zika, we know that the future might hold new variants and new findings. Eye care professionals play a vital role in keeping up with the latest research in our continued efforts to best serve our patients.

References:

  1. Cleveland Clinic. Ocular herpes (eye herpes). Updated February 19, 2024. Accessed August 8. 2024. https://my.clevelandclinic.org/health/diseases/ocular-eye-herpes
  2. Devilliers M-J, Ben Hadj Salah W, Barrearu E, et al. [Ocular manifestations of viral diseases.] Rev Med Interne. 2021 Jun;42(6):401-410. doi:10.1016/j.revmed.2020.08.022
  3. Solano D, Fu L, Czyz CN. Viral conjunctivitis. StatPearls, National Library of Medicine. Updated August 28, 2023. Accessed August 8, 2024. https://www.ncbi.nlm.nih.gov/books/NBK470271/
  4. Hoffman J. Adenovirus: ocular manifestations. Community Eye Health. 2020;33(108):73-75. PMID: 32395030
  5. University of Missouri School of Medicine. Singh receives nearly $2 million to investigate link between Zika virus and congenital glaucoma. September 21, 2021. Accessed August 8, 2024. https://medicine.missouri.edu/news/singh-receives-nearly-2-million-investigate-link-between-zika-virus-and-congenital-glaucoma
  6. Ventura CV, Ventura LO. Ophthalmologic manifestations associated with Zika virus infection. Pediatrics. 2018 Feb;141(Suppl 2):S161-166. doi:10.1542/peds.2017-2038E
  7. Hu K, Patel J, Swiston, Patel BC. Ophthalmic manifestations of coronavirus (COVID-19). StatPearls, National Library of Medicine. Updated May 6, 2024. Accessed August 8, 2024. https://www.ncbi.nlm.nih.gov/books/NBK556093/  

 

JAI G. PAREKH, MD, MBA, FAAO is the co-founder of EyeCare Consultants of NJ. He is also Chief of Anterior Segment Ocular Surgery and the Medical Director of the Research Institute at St. Joseph's Health System, NJ. Dr. Parekh also serves on the Cornea Service at the New York Eye & Ear Infirmary of the Icahn School of Medicine at Mt. Sinai (NY) where he is also Clinical Associate Professor.

 

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