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JAMA Ophthalmology Clinical Challenge
June 2016

Periocular Rash in a Healthy Teenager

Author Affiliations
  • 1Glick Eye Institute, Indiana University School of Medicine, Indianapolis
  • 2Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
JAMA Ophthalmol. 2016;134(6):707-708. doi:10.1001/jamaophthalmol.2015.4982

An adolescent boy was referred to the emergency department for suspected herpes zoster infection by his pediatrician. He presented with a 2-day history of painful, left-sided vesicular rash around his eyelid and forehead. Medical history was significant for a heart murmur with no known history of chickenpox. His pediatrician prescribed oral acyclovir and ibuprofen as needed for pain. Best-corrected visual acuity was 20/20 OD and 20/25-2 OS. On examination, clear vesicles on erythematous bases were noted in the V1 distribution with left upper eyelid edema and erythema. Pupils were equally reactive with no relative afferent pupillary defect. Visual fields were full in both eyes. Anterior examination was significant for left-sided conjunctivitis, dendritic keratitis (Figure), and anterior uveitis. The findings of the remainder of the examination, including the anterior segment of the right eye and the dilated fundus examination of both eyes, were unremarkable.

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