Acute red eye with vesicular upper hemifacial rash in an older patient

Case presentation

Mr L, a 68-year-old man, presented to his GP with a two-day history of a blistering right-sided upper facial rash and a right eye that was irritable and red. The rash had developed in the same distribution as tingling ‘electric shock’ pains he had first noticed five days earlier.

Apart from mild hypertension treated with lifestyle modifications, he had no general medical or ocular history of note, and he took no medications. When asked specifically, he recalled having chickenpox as a young child. He did not mention any recent opportunistic infections to suggest an immunocompromised state, but he reported the recent collapse of his family business as a source of considerable stress.