Viral dermatitis of the eyelid is less common compared to bacterial infections of the eyelid. It primarily includes herpes simplex dermatitis of the eyelid and herpes zoster dermatitis of the eyelid.
Herpes Simplex Dermatitis of the Eyelid
This condition is an acute inflammatory disorder of the periorbital skin caused by herpes simplex virus type 1 (HSV-1). The virus, which remains latent in the body, tends to reactivate during episodes of colds, high fever, or when the immune system is weakened. Most cases of herpes simplex dermatitis of the eyelid are recurrent and typically recur in the same location.
Clinical Manifestations
The lesions can occur on both the upper and lower eyelids, with the lower eyelid being more commonly affected, corresponding to the distribution of the infraorbital branch of the trigeminal nerve. Early symptoms include the appearance of clustered papules on the eyelid skin, which quickly progress into small, translucent vesicles surrounded by erythema. Eyelid edema often occurs alongside pricking sensations and burning discomfort around the eyes. The vesicles are prone to rupture, causing yellow, sticky exudate. After approximately one week, congestion diminishes, swelling subsides, vesicles dry out, and crusts fall off without scarring, though mild pigmentation may remain. Recurrences are possible. If the lesions extend to the eyelid margin, there is a potential for spreading to the cornea. Similar lesions can occur on the lips and the nasal vestibule.
Diagnosis
The diagnosis is made based on the clinical history and characteristic ocular manifestations.
Treatment
Treatment options include:
- Maintaining cleanliness of the eyes to prevent secondary infections.
- Using antiviral eye drops in the conjunctival sac to prevent the infection from spreading to the cornea.
- Applying antiviral eye ointments to the skin lesions.
Herpes Zoster Dermatitis of the Eyelid
This condition is caused by varicella-zoster virus infection involving the trigeminal ganglion or the first branch of the trigeminal nerve.
Clinical Manifestations
Prodromal symptoms, such as general malaise and fever, often precede the onset of the disease, followed by severe neuralgia in the affected area. A few days later, the eyelid, forehead, and scalp on the affected side develop redness and swelling, as well as clusters of small, transparent vesicles. The distribution of the vesicles does not cross the midline boundary of the eyelid and nose. The vesicles are surrounded by erythema at the base, while the skin between clusters appears normal. Over several days, the vesicle fluid becomes turbid and purulent, leading to the formation of deep ulcers. At this stage, preauricular lymphadenopathy, tenderness, fever, and systemic malaise may occur. After approximately two weeks, the crusts fall off. Due to dermal involvement, permanent skin scars may remain after the lesions heal. Skin sensation is slow to recover, often taking months. Concurrent ipsilateral herpes zoster keratitis or iridocyclitis can also occur.
Diagnosis
The diagnosis is made based on the clinical history and characteristic ocular manifestations.
Treatment
Rest and improved physical resistance are essential, with analgesics and sedatives used when necessary.
When vesicles remain intact and show no secondary infection, local medication may not be required. If vesicles rupture without secondary infection, antiviral eye ointments can be applied to the affected area. In cases of secondary infection, antibiotic eye drops can be supplemented with moist compresses. Antiviral eye drops should be instilled into the conjunctival sac to prevent corneal involvement.
Severe cases may require systemic antiviral medication, intravenous administration of gamma globulin, and supplementation with vitamins B1 and B2. Additional antibiotics or corticosteroids may be considered if necessary.