Periocular Impetigo: A Distinct Clinical Entity With Ocular Surface Involvement

To characterize the clinical features, microbiological findings, and ocular surface involvement in periocular impetigo, and to compare these findings with other causes of periocular rash in pediatric patients, in order to improve diagnostic accuracy and clinical recognition.

A tertiary care pediatric and ophthalmology referral center.

We conducted a retrospective analysis of patients presenting with periocular rashes or lesions suspicious for impetigo between 2009 and 2025. Demographic characteristics, microbiological findings, and clinical documentation of ocular surface and conjunctival involvement were reviewed and compared between patients with confirmed periocular impetigo and those with alternative diagnoses.

Sixty-eight patients were included (38 females, 56%), with a median age of 10 years. Sixteen patients (23%) were diagnosed with periocular impetigo by a pediatrician or dermatologist, supported by microbiological testing when available. Staphylococcus aureus, including methicillin-resistant strains (MRSA), was isolated in 50% of tested impetigo cases. Conjunctival involvement was significantly more common in the impetigo group compared with the non-impetigo group (43.8% vs. 11.5%, p = 0.004).

Periocular impetigo should be considered in the differential diagnosis of periocular rash, alongside molluscum contagiosum, herpes simplex infection, allergic reactions, and other dermatologic conditions. Topical and/or systemic antibiotic therapy is generally associated with favorable outcomes. Increased clinical awareness and microbiological confirmation may improve diagnostic accuracy and management, particularly in pediatric populations.