Herpes Simplex Uveitis

Herpes Simplex Uveitis is a form of eye inflammation caused by infection with the herpes simplex virus (HSV). In plain English, “herpes simplex” refers to a common virus that usually causes cold sores (if it’s HSV-1) or genital sores (if it’s HSV-2), and “uveitis” means swelling or irritation of the uvea, the middle layer of the eye. When HSV reaches the eye, it can inflame structures like the iris (colored part), ciliary body (where fluid is made), or choroid (layer under the retina), leading to pain, redness, and vision problems EyeWiki.

Herpes simplex uveitis is an infectious anterior uveitis driven by active replication of HSV in the eye. PCR detection of HSV DNA in aqueous humor confirms the diagnosis. It accounts for about 5–10% of all anterior uveitis cases and often presents with high intraocular pressure, patchy iris atrophy, and keratic precipitates (inflammatory deposits on the corneal endothelium) PMC.

The virus lies dormant in nerve cells near the ear or spine and can reactivate later, traveling along nerve fibers into the eye. Reactivation often happens when the immune system is weakened by stress, illness, or other triggers. Once in the eye, HSV damages cells by replicating inside them, causing immune cells to rush in, which leads to the redness, small white blood cells floating in the fluid (called cells and flare), and sometimes even scarring if left untreated NCBI.

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Types of Herpes Simplex Uveitis

1. HSV Type 1 (HSV-1) Uveitis: HSV-1 is the most common cause. It typically starts in or near the mouth but can spread along the trigeminal nerve to the eye. When HSV-1 reactivates in the eye, it usually causes inflammation of the front part (anterior uveitis) but can also lead to keratouveitis (cornea plus uvea) EyeWiki.

2. HSV Type 2 (HSV-2) Uveitis: HSV-2 usually causes genital infections, but it can also infect the eye, especially in newborns who pass through an infected birth canal. HSV-2 eye infections often present more severely in infants but are rarer in adults NCBI.

3. Anterior HSV Uveitis: Inflammation is limited to the iris and front chamber. Signs include cells and flare in the aqueous humor, small white deposits on the back of the cornea (keratic precipitates), and sometimes high eye pressure.

4. Keratouveitis: Both the cornea and uvea are inflamed. Corneal dendritic ulcers (branching sores) appear on fluorescein staining and are a hallmark.

5. Intermediate and Posterior Uveitis (Rare): The virus can sometimes involve structures deeper in the eye, such as the vitreous (gel) or retina, leading to floaters or loss of vision in the back of the eye Wikipedia.

6. Panuveitis: All layers of the uvea are inflamed. This is the most severe form and can threaten vision if not treated promptly Ophthalmology Advisor.

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Causes of Herpes Simplex Uveitis

1. Reactivation of Latent HSV in Trigeminal Ganglion: After initial infection, HSV hides in nerve cells. When reactivated, it travels back to the eye, causing inflammation EyeWiki.

2. Primary HSV Infection: Rarely, the first time the virus enters the body, it may spread to the eye and cause uveitis NCBI.

3. Stress: Physical or emotional stress weakens immune defenses, allowing dormant HSV to reactivate Cleveland Clinic.

4. Fever or Illness: Other infections or fevers can trigger HSV reactivation and eye involvement Cleveland Clinic.

5. Immunosuppression: Conditions like HIV or medications such as steroids reduce immunity, increasing risk of HSV uveitis Cleveland Clinic.

6. Trauma to the Eye: Injury can disrupt barriers and allow HSV to replicated locally Mayo Clinic.

7. Surgery: Intraocular surgery may awaken latent virus in nerve endings Mayo Clinic.

8. UV Light Exposure: Strong sunlight may stress skin around the eye and trigger HSV reactivation Cleveland Clinic.

9. Hormonal Changes: Pregnancy or menstrual cycles can alter immunity, leading to reactivation Mayo Clinic.

10. Fatigue: Lack of sleep compromises immune function, increasing susceptibility Cleveland Clinic.

11. Cold Weather: Cold and dry conditions may stress skin and nerves, bringing on recurrences Mayo Clinic.

12. Alcohol Use: Excessive drinking weakens general immunity, making reactivation more likely Cleveland Clinic.

13. Chemotherapy: Cancer treatments can suppress immune cells that keep HSV in check Cleveland Clinic.

14. Autoimmune Diseases: Conditions like lupus or rheumatoid arthritis can flare and indirectly trigger HSV reactivation Cleveland Clinic.

15. Diabetes: Poor sugar control impairs immunity and wound healing, raising reactivation risk Mayo Clinic.

16. Malnutrition: Lack of key nutrients weakens skin and immune barriers Mayo Clinic.

17. Corticosteroid Eye Drops: Ironically, these can reduce inflammation but also lower local immunity, allowing HSV to worsen Cleveland Clinic.

18. Allergic Reactions: Severe allergies and frequent use of antihistamines may alter local immune responses Mayo Clinic.

19. Contact Lens Wear: Improper cleaning may irritate the eye and contribute to viral entry Cleveland Clinic.

20. Other Viral Infections: Concurrent infections like VZV (shingles) can disturb nerve pathways and trigger HSV in the eye Cleveland Clinic.

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Symptoms of Herpes Simplex Uveitis

1. Eye Redness: Blood vessels on the white of the eye become inflamed, turning red WikipediaMayo Clinic.

2. Eye Pain: Dull ache or sharp pain, often worse with eye movement WikipediaMayo Clinic.

3. Light Sensitivity (Photophobia): Bright light causes discomfort or spasms around the eye WikipediaMayo Clinic.

4. Blurred Vision: Inflammation and fluid shifts make images look fuzzy WikipediaMayo Clinic.

5. Floaters: Small dark spots drift across vision when inflammatory cells float in the vitreous WikipediaMayo Clinic.

6. Decreased Vision: Severe inflammation can lower visual acuity overall WikipediaMayo Clinic.

7. Tearing: Eyes may water excessively as a reflex to irritation WikipediaMayo Clinic.

8. Discharge: Sticky or clear discharge may accompany anterior involvement WikipediaMayo Clinic.

9. Irregular Pupil: Inflammation can cause the pupil to look uneven or shapeless WikipediaMayo Clinic.

10. High Eye Pressure: HSV can block fluid drainage, leading to spikes in intraocular pressure WikipediaMayo Clinic.

11. Keratatic Precipitates: Small white or pigmented spots on inside of cornea seen with slit lamp WikipediaMayo Clinic.

12. Sectoral Iris Atrophy: Parts of the colored iris may look thin or faded due to viral damage WikipediaMayo Clinic.

13. Hypopyon: Pus (white blood cells) may layer in the front chamber in severe cases WikipediaMayo Clinic.

14. Mutton-Fat Keratic Precipitates: Large greasy-looking deposits when granulomatous inflammation occurs WikipediaMayo Clinic.

15. Corneal Dendritic Ulcer: Classic branching sore on cornea visible with fluorescein staining WikipediaMayo Clinic.

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Diagnostic Tests for Herpes Simplex Uveitis

1. Slit-Lamp Examination: A high-magnification microscope with a thin beam of light helps the doctor see cells, flare, corneal ulcers, and keratic precipitates in the front of the eye AAFP.

2. Visual Acuity Test: Simple eye chart test measures how well you read letters at a distance, tracking any changes over time NCBI.

3. Tonometry: Measures eye pressure (intraocular pressure) to detect spikes that may occur in uveitis or steroid use Mayo Clinic.

4. Gonioscopy: A special lens is placed on the eye to view the drainage angle, checking for blockages by inflammatory debris nc.preventblindness.org.

5. Fundus Examination (Ophthalmoscopy): After dilating drops, the back of the eye (retina and optic nerve) is inspected for signs of posterior inflammation UCHealth.

6. Pupil Response Test: Light is shone in each eye to check for sluggish or unequal reactions suggesting iris involvement Mayo Clinic.

7. Corneal Sensitivity Test: A small puff of air or cotton wisp checks nerve function; reduced sensitivity may hint at HSV involvement Wikipedia.

8. Fluorescein Angiography: Dye is injected into a vein and photographs are taken of blood vessels in the retina, highlighting leakages from inflammation Mayo Clinic.

9. Indocyanine Green Angiography: Similar to fluorescein but uses a different dye that images deeper choroidal vessels, useful in posterior or panuveitis Wikipedia.

10. Optical Coherence Tomography (OCT): Non-contact scan that maps the retina and choroid layers, showing swelling or fluid under the retina Mayo Clinic.

11. B-Scan Ultrasonography: Sound waves produce images when the view is blocked by corneal opacities or cataract, revealing vitreous debris or retinal thickening PMC.

12. Anterior Chamber Paracentesis with PCR: A tiny sample of fluid is taken from the front chamber under sterile conditions to test for HSV DNA using PCR WikipediaPMC.

13. Aqueous Humor Viral Culture: Fluid grows in lab media to detect live virus, though this method is slower than PCR NCBI.

14. PCR Analysis of Aqueous Humor: Rapid DNA amplification test confirms viral type (HSV-1 or HSV-2) with high sensitivity and specificity PMC.

15. Goldmann-Witmer Coefficient: Measures local antibody production in the eye; values >3 suggest active intraocular infection Iris Publishers.

16. Serologic HSV Antibody Tests: Blood tests show if you have antibodies against HSV but can’t determine active eye infection alone Cleveland Clinic.

17. ELISA for HSV Antibodies: More sensitive lab test measuring specific HSV proteins in blood to support the diagnosis Cleveland Clinic.

18. Complete Blood Count (CBC): May show elevated white cells indicating general inflammation or infection The Journal of Medical Optometry (JoMO).

19. Erythrocyte Sedimentation Rate (ESR) & C-Reactive Protein (CRP): Nonspecific markers of inflammation that often rise during active uveitis The Journal of Medical Optometry (JoMO).

20. HLA-B27 Typing: Genetic test for a marker associated with acute anterior uveitis, useful if recurrent episodes suggest an autoimmune link AAO

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Non-Pharmacological Treatments

Supporting comfort and reducing symptom severity can be achieved with these evidence-based supportive measures:

1. UV-Protective Sunglasses
   Description: Wraparound sunglasses blocking UVA/UVB.
   Purpose: Alleviate photophobia.
   Mechanism: Filters harmful wavelengths that trigger light sensitivity Uveitis.org | OIUF.

2. Cold Compresses
   Description: Gently applied chilled eye pads for 5–10 minutes.
   Purpose: Reduce pain and swelling.
   Mechanism: Vasoconstriction limits inflammatory mediators.

3. Darkened Environment
   Description: Dim lighting or blackout curtains.
   Purpose: Minimize light-induced discomfort.
   Mechanism: Reduces photic stimulation of inflamed iris.

4. Digital Screen Rest
   Description: Limiting smartphones, computers, and TV.
   Purpose: Prevent eye strain and glare.
   Mechanism: Lowers metabolic demand on inflamed tissues.

5. Tinted/Photophobic Lenses
   Description: Specially tinted spectacle lenses.
   Purpose: Ease light sensitivity.
   Mechanism: Filters specific wavelengths linked to photophobia AAO.

6. Humidifier Use
   Description: Room humidifiers in living and sleeping areas.
   Purpose: Maintain ocular surface moisture.
   Mechanism: Prevents tear film evaporation and surface irritation.

7. Ocular Rest Regimen
   Description: Scheduled periods of eye closure and rest.
   Purpose: Reduce ciliary muscle spasm.
   Mechanism: Lessens inflammatory metabolite buildup.

8. Contact Lens Avoidance
   Description: Discontinuation until uveitis resolves.
   Purpose: Prevent corneal irritation and secondary infection.
   Mechanism: Eliminates mechanical trauma and microbial reservoirs.

9. Eyelid Hygiene
   Description: Gentle lid scrubs with diluted baby shampoo.
   Purpose: Maintain meibomian gland function.
   Mechanism: Supports stable tear film lipid layer.

10. Adequate Hydration
    Description: Drinking 8–10 cups of water daily.
    Purpose: Support tear production.
    Mechanism: Ensures optimal aqueous layer of tear film.

11. Healthy, Anti-Inflammatory Diet
    Description: Emphasis on fruits, vegetables, whole grains.
    Purpose: Reduce systemic inflammation.
    Mechanism: Provides antioxidants that dampen immune activation Retina Associates of Western NY.

12. Stress Management
    Description: Yoga, meditation, or deep-breathing exercises.
    Purpose: Mitigate stress-induced immune flares.
    Mechanism: Lowers cortisol and pro-inflammatory cytokines.

13. Sleep Hygiene
    Description: Consistent sleep schedule, 7–9 hours/night.
    Purpose: Promote immune regulation.
    Mechanism: Supports T-cell homeostasis.

14. Smoking Cessation
    Description: Eliminate tobacco use.
    Purpose: Prevent exacerbation of inflammation.
    Mechanism: Reduces oxidative stress on ocular tissues Wikipedia.

15. Alcohol Moderation
    Description: Limit to ≤1 drink/day (women) or ≤2 (men).
    Purpose: Preserve immune competence.
    Mechanism: Prevents alcohol-induced immunosuppression.

16. Regular Ophthalmic Follow-Up
    Description: Scheduled visits every 4–6 weeks or as advised.
    Purpose: Early detection of flares or complications.
    Mechanism: Allows prompt treatment adjustments Retina Associates of Western NY.

17. Hand Hygiene
    Description: Frequent handwashing, no eye rubbing.
    Purpose: Prevent autoinoculation or secondary infections.
    Mechanism: Eliminates viral particles on fingertips.

18. Foot-Soak Therapy
    Description: Warm foot baths (36–38 °C) for 10 minutes.
    Purpose: Promote systemic relaxation.
    Mechanism: May improve peripheral circulation and comfort.

19. Acupuncture
    Description: Targeted periocular and systemic points.
    Purpose: Complementary pain relief.
    Mechanism: Endogenous endorphin release.

20. Mindfulness Meditation
    Description: Daily 10-minute guided sessions.
    Purpose: Enhance coping and pain tolerance.
    Mechanism: Central nervous system modulation.

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Drug Treatments

Evidence-based medications remain the cornerstone of HSV uveitis management. Each drug is described in simple English:

1. Acyclovir (Oral)

   • Class: Nucleoside antiviral.

   • Dosage: 400 mg five times daily for 4 weeks (induction), then 400 mg twice daily for suppressive therapy.

   • Time: Induction phase: 4 weeks; maintenance: ongoing.

   • Purpose: Inhibit HSV DNA polymerase to halt viral replication.

   • Mechanism: Triphosphorylated form competes with deoxyguanosine triphosphate, causing DNA chain termination.

   • Side Effects: Headache, GI upset, rare renal toxicity Glaucoma TodayIris Publishers.

2. Valacyclovir (Oral)

   • Class: Prodrug of acyclovir.

   • Dosage: 500 mg twice daily (induction) → 500 mg once daily (maintenance).

   • Time: Similar to acyclovir.

   • Purpose: Better absorption than acyclovir.

   • Mechanism: Converted to acyclovir in liver, then acts as above.

   • Side Effects: Similar to acyclovir, with possible malaise Glaucoma Today.

3. Famciclovir (Oral)

   • Class: Prodrug of penciclovir.

   • Dosage: 250 mg three times daily for 7–10 days.

   • Purpose: Alternative antiviral in case of intolerance.

   • Mechanism: Inhibits viral DNA polymerase.

   • Side Effects: Headache, nausea, fatigue.

4. Brivudine (Oral)

   • Class: Thymidine analogue.

   • Dosage: 125 mg once daily for 5 days.

   • Purpose: Third-line antiviral for refractory cases.

   • Mechanism: Inhibits viral DNA synthesis.

   • Side Effects: Myelosuppression (rare) Glaucoma Today.

5. Trifluridine (Topical)

   • Class: Pyrimidine nucleoside analogue.

   • Dosage: One drop 9 times daily during induction, taper to 3 times daily.

   • Purpose: Direct antiviral effect on corneal involvement.

   • Mechanism: Incorporates into viral DNA, preventing replication.

   • Side Effects: Eye irritation, superficial punctate keratitis PMC.

6. Prednisolone Acetate 1% (Topical)

   • Class: Corticosteroid.

   • Dosage: 1 drop every 1–2 hours initially, taper over weeks.

   • Purpose: Reduce anterior chamber inflammation.

   • Mechanism: Inhibits phospholipase A2 and reduces cytokine production.

   • Side Effects: Elevated IOP, cataract formation.

7. Difluprednate 0.05% (Topical)

   • Class: Potent corticosteroid.

   • Dosage: 1 drop four times daily.

   • Purpose: In severe inflammation requiring stronger steroids.

   • Mechanism: Similar to prednisolone, with better penetration.

   • Side Effects: Same as above.

8. Rimexolone 1% (Topical)

   • Class: Steroid with lower IOP risk.

   • Dosage: 1–2 drops four times daily.

   • Purpose: Inflammation control with minimized IOP rise.

   • Mechanism: Corticosteroid action.

   • Side Effects: Mild IOP elevation.

9. Cyclopentolate 1% (Topical)

   • Class: Cycloplegic/midriatic.

   • Dosage: 1 drop three times daily.

   • Purpose: Relieve ciliary spasm and prevent posterior synechiae.

   • Mechanism: Blocks muscarinic receptors, relaxing iris sphincter.

   • Side Effects: Blurred vision, photophobia.

10. Atropine 1% (Topical)

    • Class: Cycloplegic.

    • Dosage: 1 drop once daily.

    • Purpose: Long-acting pupil dilation and pain relief.

    • Mechanism: Same as cyclopentolate, longer duration.

    • Side Effects: Prolonged photophobia, systemic anticholinergic effects.

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Dietary Molecular & Herbal Supplements

Adjunctive supplements may support anti-inflammatory pathways. Doses and mechanisms below are based on clinical and experimental studies:

1. Omega-3 Fatty Acids (EPA/DHA)

   • Dosage: 1–2 g EPA+DHA daily.

   • Function: Anti-inflammatory lipid mediators.

   • Mechanism: Inhibit Th1/Th17 cytokines and NF-κB activation PMC+1.

2. Curcumin (Turmeric Extract)

   • Dosage: 500 mg three times daily (as Meriva complex).

   • Function: Anti-inflammatory and antioxidant.

   • Mechanism: Downregulates COX-2, PGE₂, IL-1, IL-6, TNF-α PubMedFrontiers.

3. Resveratrol

   • Dosage: 100–200 mg daily.

   • Function: Anti-viral and anti-inflammatory.

   • Mechanism: SIRT1 activation, NF-κB inhibition.

4. Quercetin

   • Dosage: 500 mg twice daily.

   • Function: Mast cell stabilization.

   • Mechanism: Inhibits histamine release and cytokine production.

5. Green Tea Catechins (EGCG)

   • Dosage: 300 mg EGCG daily.

   • Function: Antioxidant.

   • Mechanism: Scavenges free radicals, downregulates pro-inflammatory genes.

6. Lutein & Zeaxanthin

   • Dosage: 10 mg lutein + 2 mg zeaxanthin daily.

   • Function: Macular protection.

   • Mechanism: Filters blue light and inhibits oxidative stress.

7. Vitamin C

   • Dosage: 500 mg twice daily.

   • Function: Collagen synthesis and antioxidant.

   • Mechanism: Regenerates vitamin E, scavenges ROS.

8. Vitamin E

   • Dosage: 400 IU daily.

   • Function: Lipid membrane protection.

   • Mechanism: Prevents lipid peroxidation.

9. Vitamin D

   • Dosage: 1000–2000 IU daily.

   • Function: Immune modulation.

   • Mechanism: Promotes T-regulatory cell function.

10. Zinc

    • Dosage: 40 mg daily.

    • Function: Antioxidant enzyme cofactor.

    • Mechanism: Supports superoxide dismutase activity.

11. Selenium

    • Dosage: 200 µg daily.

    • Function: Glutathione peroxidase cofactor.

    • Mechanism: Detoxifies peroxides.

12. Boswellia Serrata (Frankincense)

    • Dosage: 300 mg standardized extract twice daily.

    • Function: Anti-inflammatory.

    • Mechanism: Inhibits 5-lipoxygenase.

13. Ginkgo Biloba

    • Dosage: 120 mg daily.

    • Function: Microcirculation enhancer.

    • Mechanism: Reduces platelet aggregation, improves blood flow.

14. Aloe Vera Extract

    • Dosage: 100 mg twice daily.

    • Function: Wound healing support.

    • Mechanism: Modulates cytokine production.

15. Astaxanthin

    • Dosage: 6 mg daily.

    • Function: Potent antioxidant.

    • Mechanism: Quenches singlet oxygen and peroxyl radicals.

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Regenerative & Stem Cell–Related Therapies

Emerging treatments for refractory cases focus on immune modulation and tissue repair:

1. Adalimumab (TNF-α Inhibitor)

   • Dosage: 40 mg subcutaneously every 2 weeks.

   • Function: Steroid-sparing in chronic non-infectious uveitis.

   • Mechanism: Blocks TNF-α to reduce inflammation Wikipedia.

2. Infliximab (Anti-TNF-α)

   • Dosage: 5 mg/kg IV at weeks 0, 2, 6, then every 8 weeks.

   • Function: For severe, vision-threatening inflammation.

   • Mechanism: Neutralizes TNF-α activity.

3. Tocilizumab (Anti-IL-6 Receptor)

   • Dosage: 8 mg/kg IV monthly.

   • Function: Refractory uveitis control.

   • Mechanism: Inhibits IL-6–mediated signaling.

4. Methotrexate (Antimetabolite)

   • Dosage: 15–25 mg weekly (oral or IM).

   • Function: Long-term immunosuppression.

   • Mechanism: Folate-antagonist reducing lymphocyte proliferation.

5. Cyclosporine (Calcineurin Inhibitor)

   • Dosage: 2–5 mg/kg/day in divided doses.

   • Function: T-cell inhibition.

   • Mechanism: Blocks IL-2 transcription, reducing T-cell activation.

6. Mesenchymal Stem Cell Therapy (Experimental)

   • Dosage: Under clinical trial protocols.

   • Function: Immunomodulation and tissue repair.

   • Mechanism: Secretion of anti-inflammatory cytokines and trophic factors ScienceDirect.

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Surgical Interventions

When medical therapy fails or complications arise, these surgeries may be necessary:

1. Pars Plana Vitrectomy (PPV)
   Procedure: Removal of vitreous gel via three small incisions.
   Why: Clears inflammatory debris, improves drug delivery, and allows diagnostic sampling Review of Ophthalmology.

2. Lensectomy & Cataract Extraction
   Procedure: Removal of the natural lens (phacoemulsification).
   Why: Treats uveitic cataract and reduces antigenic stimulus Review of Ophthalmology.

3. Trabeculectomy
   Procedure: Creates a new drainage pathway by excising part of the trabecular meshwork and forming a bleb.
   Why: Lowers intraocular pressure in uveitic glaucoma PMC.

4. Glaucoma Drainage Device (Ahmed Valve)
   Procedure: Implantation of a miniature tube shunt to drain aqueous humor.
   Why: Manages refractory uveitic glaucoma with better long-term control SpringerOpen.

5. Selective Laser Trabeculoplasty (SLT)
   Procedure: Laser pulses to trabecular meshwork to enhance outflow.
   Why: Non-invasive IOP reduction in mild uveitic glaucoma Wikipedia.

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Prevention Strategies

Preventing recurrences and complications involves these key measures:

1. Suppressive Antiviral Therapy

2. UV Protection (Sunglasses)

3. Hand Hygiene & No Eye Rubbing

4. Stress Management

5. Smoking Cessation

6. Healthy Anti-Inflammatory Diet

7. Adequate Sleep

8. Regular Ophthalmic Follow-Up

9. Hydration

10. Control of Systemic Conditions

These lifestyle and prophylactic steps have been recommended by ocular inflammation guidelines Iris PublishersRetina Associates of Western NY.

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When to See a Doctor

Seek urgent ophthalmic care if you experience:

• Sudden severe eye pain or headache.

• Marked vision loss or new floaters.

• Intense photophobia unrelieved by sunglasses.

• Eye redness with discharge.

• Persistent elevated eye pressure sensation.

Early intervention prevents vision-threatening complications EyeWikiCleveland Clinic.

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Diet: What to Eat & Avoid

Eat

• Leafy greens (spinach, kale)

• Oily fish (salmon, mackerel)

• Citrus fruits (oranges, berries)

• Nuts & seeds (almonds, chia)

• Whole grains (oats, brown rice)

Avoid

• Processed foods & trans fats

• High-sugar snacks & drinks

• Excessive caffeine & alcohol

• Deep-fried & greasy meals

A balanced diet rich in antioxidants and omega-3s supports ocular health Retina Associates of Western NY.

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Frequently Asked Questions

1. What triggers herpes simplex uveitis?
   Reactivation of latent HSV in the trigeminal ganglion due to stress, UV light, or immunosuppression PMC.

2. Is HSV uveitis contagious?
   The uveitis itself isn’t contagious, but ocular HSV infections can spread by direct contact.

3. Can it cause permanent vision loss?
   Yes—if untreated, chronic inflammation may lead to glaucoma, cataract, or macular edema Wikipedia.

4. How long does treatment last?
   Acute phase: 4–6 weeks of antivirals + steroids. Suppressive antivirals may continue indefinitely.

5. Are recurrences common?
   Approximately one-third of patients experience recurrences without suppressive therapy Uveitis.org | OIUF.

6. Can diet really help?
   A diet rich in omega-3s and antioxidants can support overall eye health but doesn’t replace medical treatment PMC.

7. What are steroid side effects?
   Elevated intraocular pressure and cataract formation with prolonged use.

8. Are biologics needed?
   Only for severe, recurrent, or non-infectious uveitis unresponsive to first-line therapies.

9. When is surgery required?
   For complications like cataract, glaucoma, or persistent vitreous haze despite maximal medical therapy.

10. Can stress reduction prevent flares?
    Stress management may reduce immune triggers but is adjunctive.

11. Is there a vaccine?
    No approved HSV vaccine for ocular disease currently exists.

12. Can contact lenses worsen it?
    Yes—contact lens wear during active inflammation can increase risk of corneal damage.

13. Should I avoid sunlight?
    Limit direct sunlight and wear UV-blocking eyewear to reduce flare risk.

14. Are herbal supplements safe?
    Most have good safety profiles but consult your doctor—interactions possible.

15. How often should I follow up?
    Every 4–6 weeks during active disease; less frequently once stable.