Severe Eczema Herpeticum With Ocular Involvement Leading to Orbital Cellulitis: A Pediatric Case Report.

Abstract

Eczema herpeticum (EH) is a superimposed cutaneous viral infection that occurs in the context of preexisting dermatoses, most commonly atopic dermatitis (AD). It typically involves the face, neck, and upper trunk. Although ocular involvement is relatively uncommon, it may present diagnostic and therapeutic challenges and pose a significant risk to vision. We report a pediatric case of EH with severe ocular involvement in a young child with underlying AD. Despite early oral antiviral and antibiotic therapy, the condition progressed rapidly to orbital cellulitis. Clinical improvement was observed following escalation to intravenous antiviral therapy, addition of topical antiviral treatment, and broadening of antibiotic coverage, with subsequent full recovery. This case highlights the importance of early recognition, close monitoring, and timely escalation of treatment in EH with ocular involvement to prevent sight-threatening complications.