Cytomegalovirus Blepharitis and Keratitis Masquerading as Eyelid Malignancy.

Abstract

Cytomegalovirus blepharitis and keratitis masquerading as eyelid malignancy. A 84-year-old male with a history of myasthenia gravis on chronic prednisone presented with the right eyelid erythema and cloudy vision. Visual acuity was 20/200 OD and 20/60 OS. Right upper and lower eyelids were diffusely thickened and inflamed with ulceration and madarosis along the eyelid margin (A). Slit lamp examination demonstrated a geographic epithelial defect with dendriform offshoots. Eyelid biopsies showed chronic inflammation and viral cytopathic effect (B). Immunostaining was positive for cytomegalovirus (C). The patient was treated with IV acyclovir and ganciclovir with improvement noted within 24 hours. Complete resolution was seen at 3 months (D). CMV most commonly presents as CMV retinitis and rarely as endotheliitis and keratitis. Conjunctival CMV infection has been detected in 20% of HIV patients and 10% of immunocompetent individuals. To our knowledge, this is the first case of CMV associated inflammation of the eyelid mucocutaneous junction in a patient immunosuppressed with steroids.