Swollen, sore red eye

Presenter: Tom Mackey, DO; Christian Anderson, DO; Jason Barr, DO
Dermatology Program: AZ Desert Dermatology
Program Director: Don Anderson, DOAZ
Submitted on: Jun 1, 2007

CHIEF COMPLAINT:  A 64 year old Caucasian female presents to our clinic complaining of a “swollen, sore red eye?for the past three weeks. In addition to her using over the counter topical antibiotics, her primary doctor placed her on ciprofloxacin 500mg P.O. Q.D., currently day 5. Both the patient and her primary doctor are concerned that her condition is worsening despite treatment.

CLINICAL HISTORY:

Signs and symptoms:  Her condition began as a suspected “bug bite which has just grown to involve the entire eye.?Part of the lesion had blistered and some oozing was noted, but no ulceration. The patient denied recent URI, fever, vision changes, ptosis or photophobia. She described some scant AM discharge from her eye without purulence.

Previous Treatment:

Other information:  Past Medical History: Hysterectomy/BSO 30 years prior, no other medical history. No history of malignancy, diabetes or immunosupression. No history of rosacea or seborrheic dermatitis.

Medicines: Other than mentioned above; multivitamin and Aspirin, 81mg qd. No use of herbal or other OTC medicines.

Allergies: No known drug allergies

PHYSICAL EXAM:

(fig. 1,2) No fever. Poorly demarcated erythematous plaque with fine scale and crust involving both eyelids and periorbital skin of the left eye. No proptosis or photophobia noted. Extra ocular movements intact. Pupils were equal, round and reactive. No corneal defects noted. No adenopathy noted.

Figure 1

 

Figure 2

LABORATORY TESTS:

DERMATOHISTOPATHOLOGY:

Figure 3

DIFFERENTIAL DIAGNOSIS:

1.   Preorbital (preseptal) cellulitis
2.   Orbital (septal) cellulitis
3.   Blepharitis
4.   Contact dermatitis
5.   Herpes Zoster Ophthalmicus


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