Woman with swollen eyelids

A 29-year-old female with a past medical history of well-controlled eczema, latent herpes simplex infection, and 4 months postpartum presented to the emergency department with swelling and erythema of bilateral eyelids. Physical examination demonstrated clustered, vesicular rash to the left eyelid and right eyelid margin with mild conjunctival injection on the right (Figure 1). Slit lamp examination did not show any dendritic lesions. The patient had reactive titers to varicella zoster (previous vaccination) and negative human immunodeficiency virus (HIV) screening. The patient and partner had no history of genital herpes, but the patient did have a history of oral herpes simplex (cold sores).

The patient was diagnosed with herpes simplex infection of the bilateral eyelids. The patient was started on oral acyclovir and topical erythromycin ointment.¹ The patient had complete resolution of symptoms by the end of the acyclovir course. This presentation is rare given the bilateral presentation in an individual who is young and does not have a known immunocompromising condition.^2-4

Dr. Rajagopal has ownership interest in Esperto Medical and Chromacode, Inc. She is a Board Director and Co-founder of Esperto Medical.