Palpebral subconjunctival hemorrhages in herpes zoster ophthalmicus

A 75-year-old previously healthy woman was referred for evaluation of pain and foreign body sensation in her left eye of 4 days' duration. Two weeks before presentation she was diagnosed with herpes zoster involving the left forehead and temple area and started on famciclovir treatment. Examination of her left cornea revealed inferior superficial punctate keratitis, but no dendrites or pseudodendrites. Upper eyelid eversion disclosed unusual raised palpebral subconjunctival hemorrhages on the left side. She was started on topical prednisolone eyedrops in the left eye, and her symptoms improved over the following week. Herpes zoster ophthalmicus can initially present in the eyelids. Careful follow-up with particular attention to the eyelids and eyelid eversion is recommended in any patient presenting with herpes zoster to detect early ocular involvement.