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Endgames Spot Diagnosis

Facial rash and ocular pain

BMJ 2021; 375 doi: (Published 21 October 2021) Cite this as: BMJ 2021;375:n1965
  1. D Fernandez-Nieto, dermatologist1,
  2. T Salva-Palomeque, ophthalmologist2
  1. 1Department of dermatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
  2. 2Department of ophthalmology, Hospital Universitario Ramón y Cajal, Madrid, Spain
  1. Correspondence to D Fernández-Nieto fnietodiego{at}

A previously healthy man in his 60s presented to the emergency department with ocular pain, red eye, and mild bilateral visual deterioration for one week. Pruritic facial lesions appeared two days before the ocular symptoms. Scattered erythematous blisters and crusts were seen across his face and anterior neck, without dermatomal distribution or oral involvement (fig 1). Ophthalmological examination showed a normal pupillary reaction, mild ciliary hyperaemia, and multiple diffuse dendritic epithelial ulcers throughout the cornea in both eyes (fig 2) (a dendritic ulcer is a linear, branched lesion with terminal bulbs and raised epithelial edges, affecting beyond the basement membrane). The patient had no …

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