A man in his 50s presented with redness, foreign body sensation, and tearing in the left eye (Figure, A) after a hike the previous day. He also noted red spots on his arms and legs. He denied blurry vision, discharge, photophobia, fevers, allergies, or recent illnesses. He had no other medical history or medication use.
Physical examination demonstrated discrete papules 5 mm in diameter with dark centers, localized to his extremities and trunk (Figure, B). His wife had picked him up after his hike and developed a similar lesion on her left arm. The patient had conjunctival hyperemia in his left eye.