Eyelid Lesions Research Articles

Clinical Profile and Management Outcomes of Periocular Molluscum Contagiosum

Purpose: To study the clinical profile and management outcomes of histopathologically proven cases of eyelid molluscum contagiosum (MC). Materials and Methods: A retrospective analysis of the medical records of patients presenting to a tertiary eye care center between January 1995 and December 2018 was carried out. Of 67 patients clinically suspected of harboring molluscum lesions of the eyelids, 32 were confirmed on histopathology. Results: Mean age of the patients was 7 years (1.3–69). Of 32 patients, 17 (53%) were males and 15 (47%) were females. Eyelid mass lesion was the most common complaint (87.5%). Lower eyelid was the most common site (14/44%). Eighteen (56%) patients had a solitary lesion whereas 14 (44%) had multiple lesions. Characteristic umbilication was seen in 14 (44%) cases. Associated ocular surface findings were observed in 21 (66%) patients, of which most commonly noted were follicles, papillae, and eyelid edema. Lymphadenopathy was observed in two patients. Excision with or without cautery was performed in all patients. One patient had a recurrence after 5 months. None of the patients were immunocompromised. Most common misdiagnosis was sebaceous cyst (5), chalazia (2), and viral warts (2). A positive clinicopathological correlation was found in 59.34% cases. Conclusion: MC is a common infectious eyelid lesion in immunocompetent children. Characteristic central umbilication of the lesion provides a clue to clinical diagnosis; however, it can mimic many other eyelid lesions. Complete excision offers cure in almost all cases.

Surgical Intervention of Periocular Infantile Hemangiomas in the Era of β-Blockers.

To examine the role of adjuvant surgical resection of infantile hemangiomas after systemic β-blocker therapy. This is a multicentered retrospective study. Standard protocol for oral propranolol was employed by the referring physicians. Ocular indications for surgery included ptosis obstructing the visual axis, high degrees of astigmatism causing amblyopia, or disfigurement from residual tumor. Patients underwent complete excision or debulking. Eleven girls and 4 boys were surgically treated with mean operative age of 34.4 months. Patients were followed for a mean of 19.6 months after surgery. Four patients required surgical treatment due to an inability to tolerate medical therapy secondary to drug-related side effects (including bradycardia). The other 11 patients proceeded to surgery due to residual eyelid and orbital lesions despite medical treatment. All 15 patients underwent orbitotomy for residual hemangioma excision. Four patients also underwent simultaneous levator advancement at the time of excision. In all cases, there was resolution of ptosis with clearing of the visual axis. No complications were incurred during the surgical treatment and there were no hemangioma recurrences. This is the first study to report surgical management of periocular infantile hemangiomas recalcitrant to standard therapy in the β-blocker era. In patients with infantile hemangioma who have failed medical therapy, adjuvant surgical treatment still plays an important role. For patients with persistent tumor causing ocular sequelae, surgical intervention aimed at soft tissue debulking and ptosis repair can be successful in achieving excellent functional and aesthetic outcomes with minimal side effects.For patients with periocular infantile hemangiomas with residual soft tissue deformity following propranolol therapy, surgical treatment plays an important role in improving functional and cosmetic outcomes with minimal side effects.

The prevalence of various eyelid skin lesions in a single-centre observation study.

IntroductionThe role of the eyelids is to protect and moisturise the eye. Despite its small relative surface area, 5–10% of skin cancers originate in the eyelids.AimTo assess the prevalence of different types of skin lesions in the area of eyelids based on retrospective histopathology data from a tertiary centre.Material and methodsAmong 544 included eyelid lesions, 429 (79%) were benign and 115 (21%) were malignant. In the benign group, the most common finding was a chalazion (49.2%) followed by squamous papilloma (22.8%), seborrheic keratitis (10%), epidermal cyst (8.2%), and intradermal nevus (5.1%). Out of all malignant lesions, the most common diagnosis was basal cell carcinoma (BCC) in 110 (95.7%) patients.ResultsSquamous cell carcinoma (SCC) was diagnosed in 3 (2.6%) patients and sebaceous gland carcinoma (SGC) in 2 (1.7%). No malignant melanoma was identified in the studied group.ConclusionsAlthough benign lesions are the most common eyelid tumours, it is essential to differentiate between benign and malignant eyelid tumours because early detection and appropriate treatment may improve the cosmetic effect and reduce recurrences.

Meibomian Gland Carcinoma Masquerading As A Giant Chalazion – A Case Report

A 50-year-old male presented with a non-tender mass on the left eye upper lid that gradually increased in six months. There was no history of trauma, other tumor or surgery. With clinical diagnosis of giant chalazion incision drainage and curettage was performed. Tumor recurred at the same place after 3 months. Meibomian gland carcinoma was suspected, excised in Toto and lid was reconstructed. Histopathology of biopsy material revealed adenocarcinoma of Meibomian gland. This rare presentation of adnexal malignancy could be missed and therefore author recommend biopsy of all lid lesion when operated.

Periocular Sebaceous Carcinoma Masquerading as an Intratarsal Cyst.

A 60-year-old woman with no significant medical history presented to an outside eye care provider for a persistent right lower eyelid lesion. This lesion was diagnosed as a chalazion, and she underwent incision and drainage. Postoperatively, the lesion did not resolve and maintained the same size and appearance. She was referred 6 months later for tarsal cyst excision. Examination was remarkable for an intratarsal cystic lesion involving the margin of the right lower eyelid (Fig. A, B). There was no associated madarosis, ulceration, bleeding, keratinization, or telangiectasia. A wedge excision and reconstruction were performed. Pathologic examination revealed a poorly differentiated sebaceous carcinoma (Fig. C, D). The patient underwent a second resection and conjunctival map biopsies, which showed negative surgical margins and no conjunctival involvement. She subsequently underwent reconstruction, and there was no evidence of recurrence at 6-month follow-up.External photograph demonstrating a right lower eyelid sebaceous cell carcinoma and corresponding histological findings. A,B, The cystic lesion involves the posterior aspect of the tarsus and extends to the margin. C, Lower power photomicrograph demonstrating the cystic growth pattern of the lesion (hematoxylin and eosin; original magnification = ×10). D, High magnification photomicrograph demonstrating that the cyst wall is composed of atypical cells with marked nuclear pleomorphism and vacuolated or foamy cytoplasm in many cells (hematoxylin and eosin; original magnification = ×300).Sebaceous carcinoma is a relatively rare, aggressive malignancy most commonly arising from the periocular tissues including the meibomian glands of the tarsus, and the glands of Zeis of the eyelashes, caruncle, and skin of the eyebrow. Although sebaceous carcinoma accounts for only 0.5% of all eyelid lesions, it is the most concerning because it is associated with increased morbidity and mortality. This periocular malignancy is notoriously difficult to diagnose, masquerading as an assortment of conditions which frequently leads to delays in diagnosis and proper treatment in greater than two thirds of cases. Despite a seemingly benign appearance, any lesion with yellow coloration and thickening of the eyelid or adjacent conjunctiva should cause the clinician to consider sebaceous carcinoma as a possibility with a low threshold for biopsy.

A Histopathological study of eyelid lesions at a tertiary care Hospital

Introduction: Eyelids are affected by a variety of benign and malignant conditions. A clinical diagnosis is not always correct and hence a histo-pathological study of the lesions is necessary to arrive at correct diagnosis. Aims and Objectives: To study the prevalence of various eyelid lesions at a teaching hospital and to compare the same with other studies. Materials and Methods: The study was conducted over a seven year period from January 2009 to December 2015 at Goa Medical College, Bambolim Goa. A total of 100 patients who presented to the Ophthalmology and Plastic surgery department with eyelid lesions and who were operated were included. Histopathological examination of the excised specimens was conducted using standard processing technique and taking 5 micron sections and staining by Hematoxylin and Eosin technique. Results: A total of 100 lesions were studied, of which 50(50%) were non-neoplastic and 50(50%) were neoplastic which included 41(41%) benign tumors and 9(9%) malignant tumors. The age group ranged from 2 to 85 years with the youngest patients (2 patients who were 2yrs old) presenting with pyogenic granuloma and a dermoid cyst of the eyelid respectively and the oldest was a 85 year old female with intradermal melanocytic naevus of Left upper eyelid. Keywords: Benign, Eyelid, Lesions, Malignant.

Ocular Sporotrichosis: 26 Cases with Bulbar Involvement in a Hyperendemic Area of Zoonotic Transmission

ABSTRACT Purpose To describe 26 cases of bulbar conjunctival sporotrichosis. Methods Review of clinical records of patients with bulbar conjunctivitis due to culture-proven Sporothrix spp. infection, in Rio de Janeiro, from 2007 to 2017. Results Twenty-six patients were identified. Median age was 25 years. Adults were more affected (53.8%), followed by adolescents (26.9%). There was a predominance of women (73.1%). Twenty-four patients (96%) reported contact with cats with sporotrichosis. Twenty-one patients (80.8%) presented a primary ocular sporotrichosis. Five patients presented associated eyelid lesions, and 21 (80.8%) tarsal conjunctivitis. Parinaud oculoglandular syndrome was observed in 17 (81%) patients. Eight patients (36.4%) reported the use of steroid drops before diagnosis was made. All patients but one were treated with oral itraconazole. Twenty-three patients (88.5%) were completely cured and three (11.5%) were lost to follow-up. Eight patients (34.8%) developed ocular sequelae. Conclusion Bulbar conjunctivitis is an important clinical presentation of ocular sporotrichosis. It can lead to ocular sequelae. Sporotrichosis should be considered in the differential diagnosis of ophthalmic external diseases, especially in patients with cat contact history

Eyelid lesions in general practice.

Patients with eyelid lesions often present in the primary healthcare setting. Although most eyelid lumps arebenign, accurate diagnosis and early recognition of sinister lesions leads to improved patient outcomes. The aim of this article is to provide anoverview of common eyelid lesions presenting to the general practitioner. The majority of eyelid lesions are benign, ranging from innocuous cysts (cysts of Moll, Zeis and epidermoid cyst) and chalazion/hordeolum to naevi and papillomas. Key features that should prompt further investigation include gradual enlargement, central ulceration or induration, irregular borders, eyelid margin destruction or loss of lashes, and telangiectasia. The presence of these features should prompt referral to an ophthalmologist for further evaluation.

A Clinical Masquerader: Squamous Cell Carcinoma of the Eyelid Previously Diagnosed as an Eye Bump

Malignant eyelid tumors are often difficult to diagnose at early stage growth, and can be clinically challenging. Due to the high prevalence of periocular skin cancers, clinicians must be very attentive in their assessment of skin lesions amongst their patients. This case report highlights an early non-healing eyelid lesion transforming into squamous cell carcinoma. An 83-year-old male with no history of malignancy presented with a non-healing and rapidly growing lesion of the left lower eyelid. He first noticed this lesion one-month prior and was treated with oral antibiotics without improvement by his primary care provider. Our slit lamp examination of the left eyelid revealed a large ulcerated mass with white mucoid discharge draining from the center of the lesion. After an oculoplastics referral, the patient was diagnosed with squamous cell carcinoma confirmed by biopsy. Computed tomography(CT) showed no metastasis or invasion to deep layer tissue. The management decision in this case required exenteration of the left eye socket followed by radiation therapy. This case illustrates the clinical course and invasive nature of periocular squamous cell carcinoma. It can present in a variety of different appearances, but are mostly painless, hyperkeratotic lesions that progressively change and ulcerate. An extensive history and careful clinical examination are vital in order to detect malignancy in a timely manner.

Schwannoma of the eyelid. A case report

Abstract The case is presented of a 57 year-old man with a one-year history of enlargement of the left upper eyelid. An excisional biopsy was performed, and the histological and immunohistochemical study confirmed the diagnosis of schwannoma. Schwannomas are benign peripheral nerve sheath tumors, derived from a Schwann cells proliferation. Eyelid involvement is extremely uncommon. To make the diagnosis, a detailed histopathological and immunohistochemical study is essential. This case suggests that schwannomas should be included within the differential diagnosis of any solid eyelid lesion.

Profile of Eyelid lesions: A Histopathological Study from a Tertiary Care Centre in Ajmer

Profile of Eyelid lesions: A Histopathological Study from a Tertiary Care Centre in Ajmer

Long-term outcome, relapse patterns, and toxicity after radiotherapy for orbital mucosa-associated lymphoid tissue lymphoma: implications for radiotherapy optimization.

Although mucosa-associated lymphoid tissue lymphoma (MALToma) is sensitive to radiation therapy (RT), the optimal RT dose and treatment volumes have not been established. This study aimed to assess the relapse patterns and outcomes of patients with orbital MALToma who underwent RT and to suggest implications for optimized RT. We reviewed 212 patients (246 orbits) diagnosed with orbital MALToma who received RT between 1993 and 2013. Median RT dose was 25.2 Gy. Generally, conjunctival and eyelid lesions were irradiated with electrons, whereas retrobulbar and lacrimal gland lesions with photons. Lens shielding was used for 70% of treated eyes, mainly conjunctival and eyelid tumors. Relapse occurred in 29 patients. Among 11 patients with local relapse (LR), 4 were attributed to insufficient dose (n = 2) and improper RT volume (n = 2). The 10-year LR, contralateral orbit relapse, and distant relapse rates were 8.6%, 12.8% and 4.9%, respectively. Twelve patients died of disease-specific causes (n = 1) and intercurrent diseases (n = 11). The 10-year relapse-free survival, overall survival, and cause-specific survival rates were 69.7%, 88.2% and 98.8%, respectively. Grade 3 cataracts and nasolacrimal duct obstruction were observed in 27 and 4 orbits, respectively. Low-dose RT with proper lens shielding is an appropriate treatment for orbital MALToma in terms of high disease control rate and acceptable morbidity. However, lower RT dose may be attempted to further reduce toxicity while maintaining excellent outcomes.

Sclerotherapy for eyelid and anterior orbital venous-lymphatic malformation

PurposeTo assess the efficacy of sclerotherapy with sodium tetradecyl sulfate (STS; Fibrovein 1%) in superficial periocular venous and lymphatic malformations. MethodsEleven patients with low-flow venous and lymphatic malformations with extension predominantly to the eyelids, conjunctiva, and anterior orbit were selected. Sclerotherapy with STS was undertaken as an office-based procedure without any radiological guidance. Injections were repeated every 4 weeks until desired response occurred. Therapeutic effect was assessed objectively by change in the size of the lesions in serial photography. ResultsThe lesions completely resolved in 4 cases with small eyelid and fornix lesions. In other 7 cases there was partial resolution to less than half of primary size. We did not have any significant complications. ConclusionSclerotherapy with STS is an easy and effective modality for treatment of venous-lymphatic malformations and can be undertaken as an office-based procedure in lesions which are limited to eyelids and anterior orbit.

The eyelid tumor in Yogyakarta, Indonesia

Many types of eyelid tumors may easily be diagnosed from a clinical point of view. However only a small number of large studies exist exploring the frequency of eyelid lesions from different regions. According to the epidemiology of various eyelid lesions happened in Yogyakarta Special Region, this study was aimed to investigate the prevalence of eyelid tumors in Yogyakarta Special Region. A total of 94 patients were enrolled in a descriptive study. The data were taken retrospectively from the medical record. All patients were diagnosed with eyelid tumors from January 2014 until December 2017 by histopathological examination. Among the subjects, 56 (59.6%) were male and 38 (40.4%) were female. There was no difference found in laterality (OD 46% vs OS 50%). Sebaceous carcinoma was found in 15 (16%) patients, followed by squamous cell carcinoma (SCC) 13 (13.8%), basal cell carcinoma (BCC) 11 (11.7%), epidermoid cyst 7 (7.4%), non-Hodgkin lymphoma 7 (7.4%), and others. We also found that 11 (11.7%) of patients showed an inflammation appearance only. The therapy was varied from extirpation and biopsy (39.4%), wide excision (27.7%), excision and biopsy (18.1%), exenteration (10.6%), and also anterior and lateral orbitotomy (2.1%) for each procedure. The eyelid tumor was found equally in the right and the left eye. Sebaceous carcinoma followed by SCC and BCC were the most common eyelid tumor found in this study. A further study is needed to determine the risk factor of each tumor.

Histomorphological spectrum of eyelid lesions–A 6 year retrospective study

Background: Eyelid lesions are encountered by all primary care physicians and Ophthalmologists. Histology of eyelid comprises various components and structures that give rise to a wide spectrum of pathologies. The clinical presentation of eyelid lesions is myriad with benign lesions masquerading malignant tumours. Though eyelid lesions are fairly common in Indian subcontinent, there is paucity of reports in Indian literature. This study was undertaken to characterize the distribution of various eyelid lesions and clinicopathological correlation in a tertiary care centre of South India. Objectives: To retrospectively carry out a clinicopathological analysis of eyelid lesions requiring surgical excision in the Department of Pathology of a tertiary care centre in South India. Methods: A retrospective review of clinicopathological profile of excised eyelid lesions diagnosed in our tertiary care centre was done. Clinicopathological data were retrieved from patient’s clinical records and biopsy reports. Result: Among 219 eyelid lesions, 192 were benign lesions and 27 were malignant tumours. The most common eyelid lesion was dermoid cyst (69 cases) followed by Nevus (32 cases) and Pyogenic Granuloma (12 cases). The most common malignant eyelid lesion was Sebaceous Cell Carcinoma (13 cases). Conclusion: Dermoid cyst and Nevus are the most common eyelid lesions requiring biopsy and sebaceous cell carcinoma is the most common malignant eyelid tumour. All surgically excised eyelid lesions must be subjected to histopathological examination without fail to provide a definitive diagnosis, continued patient care and management.

Bilateral eyelid Kaposi's sarcoma in an HIV-negative patient

Abstract Case report We report a case of 70-year-old male from Sicily, who presented with a bilateral eyelid mass involving the tarsal conjunctiva, found to be Kaposi's sarcoma on histologic examination. Cutaneous and pulmonary Kaposi's sarcoma involvement was documented. The patient had no prior diagnosis of human immunodeficiency virus infection. This case was managed successfully after the completion of five cycles of chemotherapy with liposomal doxorubicin, and his eyelid, skin and pulmonary lesions disappeared. Conclusions Location in the eyelid is a possible, though rare, initial solitary manifestation of Kaposi's sarcoma in elderly HIV-negative patients. Liposomal doxorubicin is a safe and effective treatment.

Clinical outcome observation of the embolization of orbital vascular malformation with medical glue under direct intra-operative view

BackgroundOrbital vascular malformation often encircles normal tissue with ill-defined borders. It is easy to bleed during resection operation, making surgical treatment difficult and lesions hard to be removed completely. In this study we aimed to summarize the treatment outcomes by embolizing orbital vascular malformation with intraoperative intracavitary injection of medical glue .MethodsA retrospective observational and cross-sectional case series study enrolled 31 patients (male = 9, female = 22) with orbital vascular malformations, who were treated from March 2008 to September 2017 at our institution. The clinical features, operation records, pathological reports and follow-up data were analyzed.ResultsThe location of vascular malformations involved intraorbital (14 cases), superficial area of eyelid and/or face (7 cases), both intraorbital and superficial area (10 cases). Imaging examination showed a solitary mass with regular shape in 8 cases and a space occupying lesion with irregular shape and ill-defined margins in 23 cases. There were 9 cases had optic nerve involved. Surgical debulkling were performed via skin incision on the mass surface (5 cases), lateral orbitotomy (2 cases), and anterior orbitotomy (24 cases). During the operation, lesions were partly exposed and injected with medical glue. The amount of injected glue was 0.25 ml to 2.5 ml in divided doses. The lesions and remnant glue were removed after the glue had turned hard. The whole procedure caused less bleeding and was easier performing than usual. Topical skin aseptic inflammation took place on the same side of the superficial eyelid lesions in 3 cases. One patient suffered from sudden central retinal artery embolism on the third day post operation. With timely rescue and appropriate procedure, visual acuity recovered to 20/32. There were no recurrences in 29 cases.ConclusionsEmbolization of orbital vascular malformation with medical glue intraoperatively made it easy to control hemorrhage. Surgeons should be careful with glue application methods in order to avoid complications.

A retrospective study of 2228 cases with eyelid tumors.

To describe the histopathologic and clinical features of eyelid tumor cases from Tianjin Eye Hospital during 2002 to 2015. In this retrospective study, a total of 2228 cases of eyelid tumors with pathologic diagnoses were enrolled. The eyelid tumors were classified into three groups according to tumor origin: epidermal, adnexal and miscellaneous, including melanocytic, neural and vascular lesions. Inflammatory tumor-like lesions were excluded. The clinical characteristics of the eyelid tumors were analyzed, including age, gender and lesion location. Most eyelid tumors were epidermal in origin (1080, 48.5%), followed by miscellaneous (885, 39.7%) and adnexal tumors (263, 11.8%). Among all the tumors, 292 (13.1%) were malignant lesions, 1910 (85.7%) benign and 26 (1.1%) premalignant lesions. Most malignant tumors originated from epidermal cells (60.0%), followed by adnexal cells (34.6%). The most common malignant tumors were basal cell carcinomas (56.5%) followed by sebaceous carcinoma (34.6%), squamous cell carcinomas (3.8%) and lymphoma/plasmocytoma (1.7%). The benign and premalignant eyelid lesions mostly originated from epidermal cells (46.4%) followed by miscellaneous cell sources (45.2%), including melanocytic nevus (33.8%), seborrheic keratosis (13.7%), squamous cell papilloma (13.0%) and epidermal cysts (11.5%). Eyelid tumors are mostly epithelial in origin. Benign tumors are significantly more common than malignant tumors with an obvious female predominance, and the most frequent malignant tumor are basal cell carcinoma, sebaceous carcinoma and squamous cell carcinomas. The tumor clinical features varied among the different subtypes.

Schwannoma de párpado, a propósito de un caso

The case is presented of a 57 year-old man with a one-year history of enlargement of the left upper eyelid. An excisional biopsy was performed, and the histological and immunohistochemical study confirmed the diagnosis of schwannoma. Schwannomas are benign peripheral nerve sheath tumours, derived from a Schwann cells proliferation. Eyelid involvement is extremely uncommon. To make the diagnosis, a detailed histopathological and immunohistochemical study is essential. This case suggests that schwannomas should be included within the differential diagnosis of any solid eyelid lesion.

IMPROVEMENT OF SYSTEMIC SCLEROSIS-LIKE SYMPTOMS AFTER THERAPY FOR MULTIPLE MYELOMA

Introduction Systemic sclerosis is known to carry an increased risk of malignancy. In this report we describe a rare case of systemic sclerosis as the presenting sign of amyloidosis associated with multiple myeloma. Case Description A 59-year-old woman presented to the clinic with a 6-month history of bilateral hand pain and puffiness. Physical examination revealed melasma, multiple enlarged right supraclavicular lymph nodes, and sclerodactyly. Laboratory tests were positive for antinuclear antibodies (1:160) in a nucleolar pattern and nephrotic range proteinuria (>8g/day). The initial impression was systemic sclerosis associated arthritis and patient was treated with hydroxychloroquine, resulting in slight improvement in her range of motion. Computed tomography of the neck showed mildly enlarged right supraclavicular lymph nodes measuring up to 1.6 centimeters in diameter. Biopsy of a cervical lymph node revealed malignant lymphoma. Bone marrow biopsy showed plasma cell myeloma (>80%); serum immunoelectrophoresis revealed elevated levels of free kappa lambda light chains (8447 mg per liter; reference range, 3.3-19.4). Initial management included cyclophosphamide, bortezomib, and dexamethasone, resulting in significant improvement in joint pain. Furthermore, she developed multiple periorbital papules. A biopsy of her left upper eyelid lesion demonstrated apple-green birefringence after Congo red staining, compatible with a diagnosis of amyloidosis. Discussion This patient initially presenting with a picture suggestive of systemic sclerosis was subsequently diagnosed with multiple myeloma and amyloidosis. She developed significant improvement in the range of motion of her finger joints as well as the skin tautness after initiating chemotherapy.