Case 1

Chief complaint
Mr. GH (a 74-year-old male) was treated for conjunctivitis (OS) with Ocuflox. He reported back to the office 2 days later for follow-up. Some improvement was noted; however, he still complained of redness, foreign-body sensation, and tender left upper lid.

History
Past Ocular History: Chronic open angle glaucoma (COAG) S/P selective laser trabeculoplasty (SLT) for 2 weeks. Presently treated with Xalatan qhs OU. Past problems of nonresponsive or allergic reactions to other glaucoma medications. Questionable SLT response. Has trouble keeping IOP under control.
Past Medical History: Unremarkable. Recent history of lip herpes, no other facial lesions.

Exam

	OD	OS
Best corrected visual acuity:	20/25	20/30
External:	trace injection	2+ diffuse injection with watery discharge
Pupils:	PERRLA
Slit lamp:	within normal limits	cornea clear with no staining; anterior chamber clear; lid lesion (refer to videos below)
IOPs (applanation tonometry):	25mmHg	24mmHg

Left upper lid.
White light. [view video]	Fluorescein with cobalt filter. [view video]	Lissamine green. [view video]

Assessment
Herpes simplex blepharoconjunctivitis with ulcerative lid lesion (workup ruled out Herpes zoster). COAG--Not at goal; mild visual field defects OU.

Plan/Treatment (aggressive!)

• Discontinued Ocuflox and Xalatan
• Began 1% Viroptic solution q2h x 5 days
• Began 500 mg Valtrex po tid x 7 days

1-week follow-up

• Resolved lesion
• IOPs (applanation tonometry): OD 31mmHg, OS 29mmHg
• Began monocular trial of 0.5% Betimol q am--rule out contraindications to beta blockers

2-month follow-up: OD 21mmHg, OS 21mmHg. At goal?