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JAMA Ophthalmology Clinical Challenge
May 21, 2020

Varicella-Zoster Virus of the Eyelid

Author Affiliations
  • 1Wills Eye Hospital, Philadelphia, Pennsylvania
  • 2TOC Eye and Face, Austin, Texas
JAMA Ophthalmol. 2020;138(7):795-796. doi:10.1001/jamaophthalmol.2020.0575

A 66-year-old healthy man presented with a 9-day history of a progressively enlarging right lower eyelid lesion. He was seen by an outside ophthalmologist and prescribed oral amoxicillin/clavulanic acid (675 mg/125 mg) and ophthalmic tobramycin for presumed bacterial infection without improvement. The lesion was not painful but was associated with ipsilateral facial numbness. On examination, he manifested a 9 × 6-mm ulcerated marginal lesion of the central right lower eyelid with surrounding edema and erythema (Figure 1). There was no associated lash loss and the region was nontender to palpation. There was notable hypoesthesia in the distribution of the trigeminal maxillary branch. On examination, his best-corrected visual acuity was 20/20 OU. The pupils were round and brisk without an afferent pupillary defect. He manifested full extraocular movements. The anterior segment examination, applanation tonometry, and dilated fundus examination results were within normal limits.

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