HSV Blepharitis

Herpes simplex blepharitis demonstrating clustered vesicles and ulcerated lesions on the upper lid.

  • May present as a primary or recurrent disease

Clinical features:

  • Symptoms:
    • Asymptomatic
    • May present with prodromal systemic symptoms such as fever, malaise, myalgias and regional adenopathy
    • Signs:
      • Primary infection:
        • Usually resolves over 2-3 week and heals without scarring
        • Becomes clinically overt in 3-9 days with manifestation of periocular clustered vesicular eruption, conjunctivitis, keratitis or preauricular adenopathy
        • The lesions usually confine to periocular region
        • Recurrent infection
          • Usually is a shorter course of disease
          • Focal clusters of vesicles or ulcerations along the lid margin may develop in 2-3 days and last for only 5 to 7 days
          • Diagnosis is made clinically

Management:

  • Prophylactic antiviral ointment or drops is indicated to protect the globe
  • Aggressive treatment is required in the presence of corneal involvement because it may cause permanent corneal scarring and visual disturbance.