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Herpes Labialis — SCE Dermatology MCQ

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HardCutaneous InfectionHerpes LabialisSCE Dermatology

A patient with recurrent herpes labialis develops a painful unilateral red eye, photophobia and reduced vision. Fluorescein examination suggests a branching corneal epithelial defect. What should the dermatologist do?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: EArrange same-day ophthalmology for suspected herpes simplex keratitis; avoid unsupervised ocular corticosteroid

Explanation lettering: D = shown as A · C = shown as B · E = shown as C · B = shown as D · A = shown as E

A is correct. Pain, photophobia, reduced vision and a dendritiform corneal epithelial lesion are red flags for herpes simplex keratitis, which is sight-threatening and requires urgent ophthalmic diagnosis and antiviral management. Topical ocular corticosteroid can worsen epithelial HSV when used without specialist supervision. B therefore risks progression. C uses a skin preparation that does not treat corneal disease and delays review. D ignores recognised ocular HSV. E misclassifies a painful photophobic visual syndrome as uncomplicated bacterial conjunctivitis. The immediate competency tested is urgent escalation, not empiric outpatient manipulation of ocular antivirals or steroids.

Reference: BAD herpes simplex information: https://www.bad.org.uk/pils/herpes-simplex; NHS herpes simplex eye infection guidance: https://www.nhs.uk/conditions/herpes-simplex-eye-infections/