Herpes Simplex Virus Blepharitis

dok_zlo — 31.10.2025

A healthy 30-year-old man presented to the ophthalmology clinic with a 3-day history of recurrent, painful bumps on his left lower eyelid. He reported having had annual recurrences of similar lesions at the same site since adolescence and that they were often triggered by psychological stress or sun exposure. Each episode had lasted 3 to 5 days and resolved spontaneously. He had not previously sought care owing to the mild and self-limited nature of the symptoms. On physical examination, clustered, umbilicated erosions and ulcers were observed on an erythematous base on the medial aspect of the left lower eyelid margin. Visual acuity and findings from a slit-lamp examination were normal. Polymerase-chain-reaction assay of a swab specimen from a lesion was positive for herpes simplex virus (HSV) type 1. A diagnosis of HSV blepharitis — with reactivation within the sensory territory of the infraorbital branch of the maxillary division of the trigeminal nerve — was made. Although HSV blepharitis may involve only the eyelid, prompt evaluation is recommended to check for concurrent ocular involvement. After a 5-day course of oral acyclovir, the lesions resolved completely. At a 6-month follow-up visit, the patient had no ocular complications.
Pablo Ros-Arlanzón, M.D., and Marta Alcaraz-Graña, M.D.Author
Published October 29, 2025
N Engl J Med 2025;393:1730
DOI: 10.1056/NEJMicm2510424
VOL. 393 NO. 17

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