Eyelids & the Anterior Segment:
                    Case thirty seven

This 16 year-old boy was referred by his family doctor because of a one-week history of painful vesicular rash.

a. What is the most likely diagnosis?

Primary herpes simplex of the eyelids.

The picture shows crusting of the rash around the right eye. The rash crosses the midline and is therefore unlikely to be caused by herpes zoster.

b. What ocular problems may arise from this condition?

In primary herpes simplex, ocular involvement can give rise to:
  • blepharitis
  • follicular conjunctivitis
  • herpes keratitis (however, this is uncommon with primary herpes simplex)

c. How would you manage this patient?

Ocular examination should be performed to look for any involvement of conjunctiva or cornea.

With primary herpes simplex dermatitis, only local hygiene is required as the disease is self-limiting. However, if the patient had a history of atopic dermatitis or immunosuppression, systemic acyclovir is required to prevent herpes viraemia which can cause visceral or cerebral involvement.

With conjunctiva or cornea involvement, topical acyclovir should be used.

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