Herpes simplex virus-1 associated third cranial nerve palsy in pediatric age group

A 4-year-old female patient presented with drooping of the right upper eyelid of 10 days duration. There was a history of low grade fever 15 days ago which subsided with the use of oral paracetamol. Abnormal head posture with mild upper lid ptosis was noted on right side. Right pupil was fixed and mid-dilated. She was diagnosed with right-sided third cranial nerve palsy. Serum and cerebrospinal fluid samples were positive for IgM antibodies to herpes simplex virus-1. The patient was treated with systemic steroids and anti-virals. The patient responded well to treatment, and there was complete resolution of ocular signs 45 days after presentation.