Painful eye with a facial rash.

A 75-year-old man presents 4 days after painful cutaneous lesions appeared on the left side of his face, associated with severe ocular pain. Two days before the eruption, he had had an intense headache, which was diagnosed as a tension headache and was treated with oral acetaminophen (Tylenol), but with no improvement. He has a history of hypertension and hyperuricemia. No recent changes have been made in his medications. Physical examination shows grouped herpetiform vesicles on an erythematous base confined to the cutaneous surface and innervated by the left first trigeminal branch (Figure 1). Palpation detects regional preauric ular and submaxillary lymphadenopathies. Ophthalmologic examination with fluorescein stain shows moderate perilimbal injection and dendritic keratitis (Figure 2). The remainder of his physical examination is normal. Laboratory tests, including red and The CliniCal PiCTure