|Herpex Simplex Blepharitis
SIGNS AND SYMPTOMS
A second erosive-ulcerative form of HSV blepharitis has also been described. This presentation is characterized by erosions of the lid at the Gray line or ulcers along the lid margin, or a combination of both. The lid typically displays generalized swelling and redness associated with these lesions.
HSV blepharitis is encountered primarily in children, although adults may also manifest this disorder. Presenting symptoms include pain and tenderness upon palpation, as well as increased lacrimation in severe cases. If the conjunctiva is involved, tarsal follicles may be observed along with bulbar injection and chemosis. Swollen pre-auricular nodes (pre-auricular lymphadenopathy) on the involved side is common.
Primary ocular infections occur most often in children between the ages of 6 months and 5 years, and almost invariably present as blepharitis or blepharoconjunctivitis. In recurrent attacks, the virus usually reappears as a dendritic keratitis. Several reports of recurrent HSV blepharitis have been reported in the literature, however.
The use of topical steroids on HSV lid lesions may be unwise, particularly if there is other ocular involvement. Although corticosteroids may be used without fear in cases of herpes zoster (HZO) blepharitis, their use in cases of HSV infection may predispose the patient to the eruption of a dendritic keratitis.
Always include HZO in the differential diagnosis of HSV blepharitis. Keep in mind, however, that HZO typically affects elderly patients over the age of 70. Younger patients who present with HZO are often immunocompromised secondary to disorders such as AIDS or lymphoma. HSV blepharitis is usually encountered in children, but can occur at any age.
Although herpes simplex is known as a sexually transmitted disease, the vast majority of ocular herpes infections are not contracted via sexual contact. This is very important to recognize when considering pediatric cases of HSV blepharitis.
Other reports in this section
Eyelids & Eyelashes | Conjunctiva & Sclera | Cornea
Uvea | Vitreous & Retina | Optic Nerve & Brain | Oculosystemic Disease
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