A Seemingly Healthy Girl With a Vesicular Rash
A Seemingly Healthy Girl With a Vesicular Rash
A 10-year-old, previously healthy girl was referred to the pediatric ophthalmology service after being seen in the emergency department for blisters and swelling to the left eye, forehead, and scalp. She was on a field trip to an aquarium and had complained of a headache and eye pain on the left side the day before the lesions appeared. She was originally seen by her primary care physician 6 days ago, and again in a different emergency center, and was given prednisone and a cream for contact dermatitis secondary to poison ivy. After worsening blistering, she presented again to the emergency department.
The child was otherwise healthy with no significant medical history and no history of recurrent infections. She had not had chickenpox but had received the vaccine. She denied any sick contacts or recent illnesses but admitted to recent stressors at school.
On ocular examination, her visual acuity was 20/20 in both eyes. Her intraocular pressure was 24 mm Hg in the left eye and 17 mm Hg in the right eye.
Examination of the left adnexa revealed reactive ptosis with upper lid swelling. The left forehead and scalp had multiple areas of vesicular rash with some areas becoming bullous. She was unable to open her left eye.
Examination of the anterior segment revealed left upper lid edema with an open vesicle on the upper lid and multiple vesicles on the lid margin (Figure). Conjunctival injection was present. Corneal sensation was reduced in the left eye. The remainder of the exam for both eyes was normal.
Figure. Vesicular rash over the left eye, forehead, and scalp, with vesicles on eyelid and lid margin.
Clinical Presentation
A 10-year-old, previously healthy girl was referred to the pediatric ophthalmology service after being seen in the emergency department for blisters and swelling to the left eye, forehead, and scalp. She was on a field trip to an aquarium and had complained of a headache and eye pain on the left side the day before the lesions appeared. She was originally seen by her primary care physician 6 days ago, and again in a different emergency center, and was given prednisone and a cream for contact dermatitis secondary to poison ivy. After worsening blistering, she presented again to the emergency department.
The child was otherwise healthy with no significant medical history and no history of recurrent infections. She had not had chickenpox but had received the vaccine. She denied any sick contacts or recent illnesses but admitted to recent stressors at school.
On ocular examination, her visual acuity was 20/20 in both eyes. Her intraocular pressure was 24 mm Hg in the left eye and 17 mm Hg in the right eye.
Examination of the left adnexa revealed reactive ptosis with upper lid swelling. The left forehead and scalp had multiple areas of vesicular rash with some areas becoming bullous. She was unable to open her left eye.
Examination of the anterior segment revealed left upper lid edema with an open vesicle on the upper lid and multiple vesicles on the lid margin (Figure). Conjunctival injection was present. Corneal sensation was reduced in the left eye. The remainder of the exam for both eyes was normal.
Figure. Vesicular rash over the left eye, forehead, and scalp, with vesicles on eyelid and lid margin.
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