Shingles and other viral issues

Case 1

A 77-year-old female came to the practice with a swollen eyelid. Our junior optometrist had a look and thought the puffy and red eyelid could be due to allergy.

Figure 1 (a): Right forehead, eyelid and nose, the latter indicating positive Hutchinson’s sign and so HZO. The eye lid is red and oedematous. There is inferior conjunctival hyperaemia and (seen on slit-lamp) a mild punctate staon on the inferior cornea. (b): Improvement after a week of treatment with acyclovir. The lid oedema and redness has improved, as has conjunctival htperaemia, and no corneal stain was found at this stage.

My first observation of the patient revealed the following (see figure 1):
• Redness of right upper and lower eyelid
• Right lower eyelid showing fluid accumulation
• Right inferior nasal conjunctiva showing hyperaemia
• Right inferior cornea revealed a tiny stain (not dendritic in appearance)
• Isolated cutaneous vesicular lesion on right forehead
• Isolated cutaneous vesicular lesion on right upper eyelid
• Isolated cutaneous vesicular lesion on right side of nose.