DR. HAGAN: Quest. about ocular herpes

Dear. Dr. Hagan:

Approx. 1 year ago I was exposed to HSV-2.  I experienced a primary genital outbreak at that time which included systemic flu-like symptoms.   During my initial exposure I inadvertently autoinoculated my eyes.  Within 2-3 days of my exposure, which I confirmed was HSV-2 through having my partner tested, I experienced conjunctivitis, burning, some discharge form eyes in morning, which would usually get better throughout day.  The symptoms (discharge, redness) lasted for a few months, but burning still persisted for almost 11 months, and has only gotten better in the last few weeks, almost 1 yr. after the exposure.  I went to an opthamologist imeddiately after the exposure, then 1 month later who used slit-lamp on both occasions, and she indicated my cornea looked good, and that there appeared to be no "significant insertion" of the virus into my eye, but that it was contained, for now to the conjunctiva.  I was on acyclovir for a couple of weeks.

I have exhaustively searched the internet for info on ocular hsv-2 and it is very sparse. Almost all info focuses on ocular HSV-1, and some sites say that ocular HSV is "only due to HSV-1 virus"  My question is:

1.  what is the prognosis for someone with ocular HSV-2?

2. because the site of preference for hsv-2 is the sacral ganglia, which is why reactivation of Oral hsv-2 is rare, does the same rule apply for ocular hsv-2?  Perhaps this is why almost all info on ocular hsv focuses on ocular hsv-1 or herpes zoster, and not hsv-2?

3. Should I be concerned about reactivation of ocular hsv-2?  And increasingly more severe symptoms with re-occurrences, such as with hsv-1?  Or is it unlikely to reactivate due to being outside of site of preference.

4.  Is the primary exposure to ocular hsv-2 typically the worst like other hsv exposures?

5. What are the chances I will someday go blind from this virus?

thank you.

Johnny.

[John C Hagan III, MD, FACS, FAAO]

1. Your prognosis is excellent. HSV 2 rarely causes serious problems. You were treated appropriately. You may have concommitent dry eyes
2. The standard risk of a HSV 1 reactivation is 50% within 5 years. Yours would be lower  but I can't quantitate further
3. Genital herpes will be far more likely a problem than ocular
4. I can't answeer that  because it varies
5. Virtually nil.

JCH MD
5.