A case of recurrent, isolated, simultaneous, bilateral herpes simplex lid infection

Ocular herpes simplex is usually diagnosed by its typical clinical presentation. It is generally accepted to be a unilateral disease, with lid eruptions typically occurring in primary ocular herpes simplex, while absent or mild in recurrent disease. Recurrent ocular herpes simplex is generally thought to be characterized by corneal involvement.

A 35-year-old woman had a 2-day history of a progressive bilateral, erythematous, vesicular rash of the upper and lower eyelids and associated preseptal cellulitis. She had a history of a recurrent, unilateral eyelid rash that was previously diagnosed as herpes zoster. The eyelid involvement was unusual because it was bilateral, severe, recurrent, vesicular, and isolated, with no additional ocular manifestations of herpes simplex. These atypical features are in contrast to the generally accepted manifestations of recurrent ocular herpes simplex. A cytologic evaluation and a viral culture confirmed infection by HSV Type 1.

Lid involvement occurs in recurrent ocular herpes simplex disease more often than generally accepted, while simultaneous bilateral disease is uncommon. As in this case, when atypical presentations occur, critical review of the differential diagnosis and use of laboratory tests are helpful.