Abstract
Purpose: To present a patient with bilateral severe and symmetric lower lid lymphedema in the setting of previous neck surgery and chronic psoriasis, and to review the potential relationships of neck surgery, irradiation, psoriasis, and rosacea to chronic lymphedema. Design: Single case report with literature review. Methods: A 60-year-old female with long-standing psoriasis presented with a 2-year history of severe, symmetric bilateral lower eyelid edema that developed after total laryngectomy and selective right neck dissection for recurrent Squamous Cell Carcinoma (SCC). 10 years prior she underwent radiation and radical left neck dissection for metastatic disease. Surgical management entailed transcutaneous debulking of the masses combined with ectropion repair and suture tarsorrhaphy. A comprehensive literature review was performed using Pubmed and Medline. Results: Surgical debulking of the soft tissue masses via a transcutaneous incision resulted in significant improvement in the patient’s lymphedema without recurrence at 5 months follow-up. Histopathologic findings were consistent with chronic eyelid lymphedema. Conclusions: Isolated eyelid lymphedema is rare, with many etiologies, and poses a diagnostic challenge. While ophthalmologists are familiar with the ocular manifestations of rosacea such as conjunctivitis or blepharitis, it is important to consider rosacea as an etiology of eyelid lymphedema. Reviewing the history for previous surgery or radiation to the head and neck, or other dermatologic inflammatory disorders is also warranted. Rosaceous lymphedema is typically less severe than in post-surgical/radiation patients, and does not respond well to medical treatment; however, it often shows a favorable response to debulking blepharoplasty surgery, with or without skin grafting. This patient with a history of severe psoriasis and bilateral neck dissections with radiation for SCC also responded well to surgery without recurrence of lymphedema. Therefore, surgical debulking can be considered in these patients with severe eyelid lymphedema as an option to markedly improve visual function and overall cosmetic appearance.
Highlights
Lymphedema occurs as a result of impairment of lymphatic drainage, leading to the accumulation of proteinrich lymphatic fluid within tissues
A 60-year-old female with long-standing psoriasis presented with a 2-year history of severe, symmetric bilateral lower eyelid edema that developed after total laryngectomy and selective right neck dissection for recurrent Squamous Cell Carcinoma (SCC). 10 years prior she underwent radiation and radical left neck dissection for metastatic disease
Isolated chronic eyelid lymphedema is rare, with only a few cases reported in the literature that are mainly associated with rosacea [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16]
Summary
Lymphedema occurs as a result of impairment of lymphatic drainage, leading to the accumulation of proteinrich lymphatic fluid within tissues. This protein-rich interstitial fluid leads to inflammation and an accumulation of fibroblasts, adipocytes and keratinocytes that transforms soft tissue into hard fibrotic tissue with stiff, thickened skin. The most common etiologies of head and neck lymphedema are associated with trauma, surgery, tumor growth, radiation and infection to the head and neck lymphatic system [1]. Lymphedema of the eyelids can be very debilitating to the patient, due to the physical appearance and from visual field obstruction. This article presents a patient with severe lower eyelid lymphedema, reviews the lymphatic drainage considerations, and the potential association of certain dermatologic diseases with lymphedema
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