A 73-year-old white female presented with a chief complaint of itchy, burning eyes (O.D.>O.S.) that had persisted for 10 days. She reported that her primary care doctor had prescribed “some cream” (sulfacetamide) and hot compresses, but they did not seem to be working. As a side note, she also asked if I knew what could be done about the lesion on the corner of her lip.

Her systemic history was remarkable for hypertension, for which she was properly medicated. In addition, the patient currently had a cold. However, she reported no known allergies to environmental contaminants or medications.

Diagnostic Data
Her best-corrected visual acuity was 20/25 O.U. at distance and near. External examination found a slightly tender, papillomacular rash in her right eye. The patient’s anterior segment examination was normal, with no corneal epitheliopathy or anterior chamber findings. Her intraocular pressure measured 14mm Hg O.U. The dilated fundus examination was normal.

Your Diagnosis
How would you approach this case? Does this patient require any additional tests? What is your diagnosis? How would you manage this patient? What’s the likely prognosis?

Additional tests might include checking the preauricular, submandibular and sublingual lymph nodes; examining the eyelid and cilia for collarettes or nits; sodium fluorescein staining to rule out epithelial compromise; and a corneal sensitivity test.

The diagnosis in this case is herpes simplex blepharitis. The patient demonstrated no fever or evidence of preseptal cellulitis. We switched the antibiotic cream to polysporin ointment and instructed the patient to apply a thin coating to the affected eyelid area b.i.d. We also prescribed lid scrubs to keep her lids clean and free of debris.

We treated her eyes with a thick artificial teardrop q2h. Additionally, we referred our patient to a dermatologist for her lip lesion. Upon examination, he determined that our patient had a stomatitis, which required a mild steroid preparation.

Eight days following treatment, our patient experienced complete ocular and systemic resolution.

1. Predictors of recurrent herpes simplex virus keratitis. Herpetic Eye Disease Study Group. Cornea. 2001 Mar;20(2):123-8.
2. Khurana AK, Ahluwalia BK, Rajan C.Chalazion therapy. Intralesional steroids versus incision and curettage. Acta Ophthalmol (Copenh). 1988 Jun;66(3):352-4.
3. Sowka JS, Gurwood AS, Kabat AG. Herpes simplex blepharitis. In: Handbook of Ocular Disease Management. Rev Optom (suppl). 2000:13a-4a.