Left Eyelid Research Articles

Use of quantum molecular resonance energy for managing postrhinoseptoplasty perilesional edema and ecchymosis.

Quantum molecular resonance (QMR) technology employs nonionizing high-frequency waves ranging from 4 to 64MHz to generate low-intensity quanta of energy that interacts with cellular components. To evaluate the efficacy and safety of QMR treatment on postoperative perilesional edema and ecchymosis in patients with rhinoseptoplasty or revision rhinoseptoplasty. In total, 30 patients were treated with QMR stimulation therapy (QMR group) once daily for 5days, while another 30 patients were treated with conventional icepack application (control group). The duration of perilesional edema and ecchymosis were comparatively evaluated according to anatomic regions. In both groups, the longest duration of postoperative edema and ecchymosis was found on the left anterior cheek, followed by the right anterior cheek, left lower eyelid, right lower eyelid, and right and left upper eyelids. The mean duration of overall postoperative perilesional edema was significantly shorter in the QMR group (2.0±0.8days) than the control group (4.6±2.0days); the mean duration of overall ecchymosis was also markedly shorter in the QMR group (2.9±1.5days) than control group (7.5±2.9days). Patient satisfaction after postoperative QMR treatment was rated as 2.2±0.8, whereas patient satisfaction in control group was rated as 1.6±0.9. Our clinical study demonstrated that postrhinoseptoplasty QMR treatment effectively reduces the duration of postoperative perilesional edema and ecchymosis without remarkable side effects. We suggest that QMR treatment can be considered as an alternative option for noninvasively managing postrhinoseptoplasty perilesional edema and ecchymosis.

Microsurgical Resection of Hybrid Nerve Sheath Tumor Involving the Orbit and Lateral Wall of the Cavernous Sinus: 2-Dimensional Operative Video.

Surgical removal of the tumor involving both the orbital and cavernous sinus remains challenging. Hybrid nerve sheath tumors (HNSTs) are defined as benign peripheral nerve sheath tumors with combined features of more than one type of benign peripheral nerve sheath tumors, including schwannoma, neurofibroma, and perineurinoma.1 They rarely arise from the orbit.1-3 This video shows the microsurgical resection of HNST involving both the orbit and lateral wall of the cavernous sinus. A 43-yr-old woman presented with 1-yr history of a slowly growing painless mass in her left medial eyelid. Neuroimaging examinations demonstrated a multilobulated and well-demarcated mass with a heterogeneous enhancement located in the extraconal region, just above the levator muscle, and extending from the eyelid to the middle fossa through the superior orbital fissure. Based on the neuroimaging features, we diagnosed it as trigeminal schwannoma involving the orbit and lateral wall of the cavernous sinus preoperatively. We performed left frontotemporal craniotomy with superolateral orbitotomy to gain access to the tumor. The tumor was grayish yellow and relatively firm. No intact nerve fibers of the frontal and ophthalmic nerves could be identified, making the diagnosis of the tumor originating from both nerves. Finally, we completely resected the tumor, which was confirmed by postoperative magnetic resonance images. Her postoperative course was uneventful, except for transient diplopia and expected left forehead hypesthesia. The pathology returned to HNST containing schwannoma and neurofibroma with no malignancy. The patient consented to the procedure prior to the surgery. And, the patient consented to the publication of their image.

Central Retinal Artery Occlusion after Filler Injection for Upper Lid Retraction

Purpose: We report a case of central retinal artery occlusion after filler injection for upper lid retraction. Diagnosis and treatment were performed to recover visual acuity and good results.Case summary: A 40-year-old woman presented to our clinic with upper lid retraction. She was diagnosed with hyperthyroidism and thyroid orbitopathy. She had been examined regularly at a local clinic since 2016. At the first visit, her visual acuity was 1.0/1.0 and the intraocular pressure was 19 mmHg, with no unusual findings in the anterior segment. Hyaluronic acid filler was injected into the medial part of the left upper lid. As soon as the needle was removed, she complained of blurry vision and visual impairment. This was followed by the development of a relative afferent pupillary defect; her visual acuity was hand motion at 30 cm. After 5 minutes, we performed wide fundus imaging and optical coherence tomography, which revealed retinal artery occlusion and a cherry-red spot, along with inner retina hyperreflectivity. Under a diagnosis of central retinal artery occlusion, we performed anterior chamber paracentesis, intravenous mannitol and acetazole injection, and an ocular massage. Approximately 1.5 hours after filler injection, retinal artery reperfusion and loss of the cherry red spot were observed and, after about 3 hours, her vision had recovered to 1.0 from hand motion at 30 cm.Conclusions: Central retinal artery occlusion after filler injection, when diagnosed promptly, can be treated by anterior chamber paracentesis, intravenous mannitol and acetazole injection, and ocular massage.

Pyoderma Gangrenosum Initially Presenting as an Ulceration of the Ear Lobule

Pyoderma Gangrenosum (PG) was first described in 1916 as “phagedenisme geometrique”, after a French dermatologist observed rapidly progressing, cutaneous necrotic lesions with sharp borders.1 In 1930, Brunsting and his colleagues at the Mayo Clinic coined the term Pyoderma Gangrenosum, because it was initially thought to arise from staphylococcal and streptococcal infections which were observed in 5 of their patients.2 The exact etiology and pathogenesis is still unknown. To date, only a few cases of PG have been shown to affect the ears, all showing no gender or age predilection.3 We report another such case.
 
 CASE REPORT
 A three-year-old girl presented at the emergency room with a non-healing, erythematous papule over her left ear lobule, allegedly following an ear piercing one month prior. She was initially treated at another institution with oral antibiotics. Despite treatment, her mother noted rapid worsening of the lesion, eventually developing into a painful ulceration and affecting the left eyelid as well. At the time of examination, the patient presented with a painful, necrotic plaque around the left eyelid with serpiginous borders (Figure 1) and ear lobule with erythematous, advancing borders (Figure 2A, B). There were no systemic co-morbidities noted. The working diagnosis then was necrotizing fasciitis and she was immediately started on systemic intravenous antibiotics which she did not respond to. Laboratory tests showed elevated CRP, but procalcitonin, C-ANCA and ANA were all normal. Tissue cultures of both eyelid and earlobe, as well as blood cultures, revealed no growth. Wedge biopsy of the eyelid ulceration revealed neutrophilic dermatitis. Biopsy of the ear lobule revealed suppurative granulomatous dermatitis with secondary leucocytoclastic vasculitis. Further workups for infection and possible systemic diseases were all unremarkable. A pathergy test was negative. A diagnosis of pyoderma gangrenosum was made after excluding systemic and infectious causes. The patient was started on systemic prednisone at a dose of 1mg/kg/day which she slowly responded to. Surgical reconstruction of the earlobe was to be planned once the ulceration completely healed; unfortunately, this patient was lost to follow-up

Eyelid Crease Height Affects the Evaluation of Age-related Changes in the Eyelids.

Background:Although the functional and anatomical differences between the left and right eyelids are important in the evaluation of age-related changes in the eyelids, they have not been described clearly as indications for surgical treatments. This study aimed to investigate how laterality of the eyelids affects evaluation of age-related changes.Methods:Photographs of either one or both eyelids of 100 people were evaluated in four stages by 10 plastic surgeons. To investigate the consistency of the results between evaluations, surgeons evaluated the single-eyelid photographs (group U) or two-eyelid photographs (group B). It was investigated whether the difference in margin reflex distance 1, height of the upper eyelid crease, height of eyebrow, and levator contractile function were associated with mismatched evaluations.Results:The weighted kappa coefficient for groups B and U was 0.77 (substantial agreement). One-point difference in scores was observed in 23 cases. In the multiple logistic regression analysis, only the laterality the height of the eyelid crease was significantly different between patients whose evaluations were matched and those whose evaluations were mismatched (0.9 ± 0.1 mm versus 1.7 ± 0.2 mm; OR = 1.06, 95%CI: 1.01–1.10; P = 0.01).Conclusions:Besides the structure and function of each eyelid, the laterality of the height of the eyelid crease was important in the evaluation of the age-related changes in the eyelids. This factor may be important in evaluating the aesthetic and visual impressions of age-related changes in the eyelids.

BURKITT LYMPHOMA PRESENTING WITH EYE AND KIDNEY INVOLVEMENT: CASE REPORT

Burkitt lymphoma (BL) is an aggressive form of B-cell non-Hodgkin lymphoma. It may present with a variety of symptoms leading to possible misdiagnosis and delay in treatment. BL is fatal if left untreated, and early diagnosis and treatment can improve prognosis. In this case report, a 3.5-year-old male patient with no known disease had left eyelid swelling and hematuria, and orbital magnetic resonance imaging performed after his admission showed contrast enhancement in the bulbus oculi, and increased uptake in both kidneys (suvmax:9.5) in positron emission tomography. The patient's bone marrow aspiration was normal. There was no involvement in the evaluation of the central nervous system. As a result of kidney biopsy, he was diagnosed with high-grade B-cell lymphoproliferative disease (Ki-67 95-100%, diffuse positivity with CD79a and EBV). Burkitt lymphoma. The treatment of the patient was started in the NHL-BFM 2012 R4 arm. At the end of the treatment, the ocular findings regressed. Burkitt lymphoma may present with different clinical presentations. If appropriate and rapid imaging techniques are used, positive results on survival can be obtained. Our patient is being followed up alive and well.

Cavernous Sinus Thrombosis as Complications of Cellulitis Orbital: Case Report

Background: Cavernous sinus thrombosis is a complication of infection around the face or paranasal sinuses with high morbidity and mortality rates. Cavernous sinus thrombosis is generally caused by septic infection, such as orbital cellulitis. Case Illustrations: A 35-year-old male who came to the neurology polyclinic complained of swelling in the left eyelid, red, watery eyes, blurred vision, difficulty opening the left eye, and the movement of the left eyeball felt normal. The patient had a history of left orbital cellulitis. Laboratory investigations showed an increase in inflammatory markers. The CT scan with contrast showed a hyperdense lesion in the left orbit, suggesting orbital cellulitis. The patient was diagnosed with a cavernous sinus thrombosis due to orbital cellulitis. He was treated with an antibiotic, anticoagulant, and corticosteroid. Three months after treatment, the visual complaints improved, the headache decreased drastically, and we did not find any extraocular muscles weakness. Conclusions: The administration of antibiotics and anticoagulant therapy in patients with cavernous sinus thrombosis has been proven clinically. The use of corticosteroids has not been proven but is strongly suspected to reduce edema caused by compression of the cavernous sinus. Keywords: Cavernous sinus thrombosis, orbital cellulitis. infections.

P04 Primary mediastinal large B-cell lymphoma in a Caucasian female with anti-SAE-1 positive dermatomyositis

Abstract Case report - Introduction This is a case of a female patient who was diagnosed with dermatomyositis with anti-Small ubiquitin-like modifier Activating Enzyme-1 (SAE-1) and anti-Ro52 autoantibodies. She had extensive skin involvement with mild extracutaneous features and responded well to a combination of prednisolone, hydroxychloroquine and azathioprine. She subsequently developed primary mediastinal large B-cell lymphoma about 3 years after diagnosis of dermatomyositis. Case report - Case description A 59-year-old Caucasian female presented in January 2018 to the dermatologist with a 6-month history of itchy, dry, flaky skin around her eyes with periorbital erythema which later progressed to fixed periorbital oedema. At that point, a diagnostic biopsy was taken from the left lower eyelid which showed a deep inflammatory infiltrate with significant oedema and dilated blood vessels. A few weeks later, she developed a widespread erythematous rash. Other than some cramps and myalgia in the thighs, there was no muscle weakness or dysphagia. There were no red flag symptoms, but some dry cough without dyspnoea. Clinical examination revealed periungual erythema, periorbital erythema and oedema, widespread erythematous eruption on the torso and limbs and papular eruptions on the hand dorsum. Muscle power in upper and lower limbs scored 5 in the MRC scale. Blood tests showed slight lymphopaenia, antinuclear antibodies titre 1:400, dsDNA and ENA negative, raised IgG kappa monoclonal protein at 10g/L with normal kappa/lambda ratio, creatine kinase initially 93 that later rose to 209, slightly raised lactate dehydrogenase 262, otherwise unremarkable biochemistry and inflammatory markers. Extended myositis screen with immunoblot revealed positive SAE-1 and anti-Ro52 autoantibodies. MRI of the femurs showed mild oedema in the adductors. Electromyogram showed some myopathic motor units, not florid but convincingly present. Computed tomography of neck, thorax, abdomen and pelvis did not reveal any underlying malignancy at the time. The diagnosis of SAE-1-positive dermatomyositis was made and she was treated with high-dose prednisolone (1mg/kg), azathioprine and hydroxychloroquine with good response and dermatomyositis went into remission. In December 2020, she developed dyspnoea and was found to have left-sided pleural effusion and anterior mediastinal mass, a biopsy of which confirmed primary mediastinal large B-cell lymphoma. She is currently receiving chemotherapy with rituximab-cyclophosphamide-doxorubicin-vincristine-prednisolone and azathioprine was discontinued. Her dermatomyositis remains in remission. Case report - Discussion The SAE-1 autoantibody was first identified in 2007. Its prevalence ranges from 1% to 8% in different cohorts. The main clinical feature of anti-SAE-1-positive disease tends to be a widespread cutaneous involvement which is typically pruritic, either amyopathic or associated with mild muscle involvement. Other extracutaneous manifestations include arthralgia, dysphagia and interstitial lung disease (ILD) with variable frequency in different cohorts. ILD is usually milder than in other amyopathic dermatomyositis subgroups. Our patient presented with rather extensive cutaneous disease (clinical photography available) requiring high-dose prednisolone and we decided to add azathioprine as a steroid-sparing agent. She had minimal muscle disease and no other extracutaneous manifestations. Interestingly, she developed lymphoma 3 years following the diagnosis of dermatomyositis. The association between dermatomyositis and malignancy is well-established. The generally accepted definition of cancer-associated myositis is malignancy within 3 years of disease onset. Dermatomyositis as opposed to polymyositis, increasing age, male sex, dysphagia, cutaneous ulceration and the presence of anti-transcription intermediary factor-1 gamma antibodies (TIF1γ) were all associated with increased cancer risk in a recent meta-analysis by Oldroyd et al. Anti-SAE-1 is variably reported to be associated with cancers. A recently published study of a North American cohort of anti-SAE-1-positive dermatomyositis patients reported five cases of cancers, mainly internal malignancies and one case of B-cell lymphoproliferative disorder. We are not aware of any more reported cases of lymphoma in patients with anti-SAE-1 autoantibodies. A 2018 study did report two cases of dermatomyositis patients who developed lymphoma without specifying the autoantibody profile in those patients. Our case contributes to the fact that dermatomyositis can be associated with malignancies. It also raises awareness that this rare subgroup of dermatomyositis with SAE-1 autoantibodies can be associated with lymphoma. However, this association has not been widely reported in the literature. Case report - Key learning points

O04 Orbital lymphoma in a 72-year-old lady with rheumatoid arthritis: an argument for rituximab

O04 Orbital lymphoma in a 72-year-old lady with rheumatoid arthritis: an argument for rituximab

P33 A female with a drooping eyelid and positive autoantibodies: mystery solved?

Case report - IntroductionThe presence of autoantibodies in IgG4-related disease (IgG4-RD) can lead to confusion and we present a case to highlight the diagnostic difficulty in this condition.Case report - Case descriptionA 63-year-old Indian female presented with progressive ptosis and swelling of the left eyelid for 2 months. She was referred to the stroke clinic where she was found to have left ptosis with associated swelling. An MRI of the orbit revealed an enlarged left lacrimal gland and mucosal thickening in paranasal sinuses. Her ESR was 20, CRP 2, 15% peripheral eosinophils and IgG 17.55 g/L (6-16). A referral was made to rheumatology due to an abnormal immunological profile: cANCA +, MPO ANCA positive 32 IU/ml (0-3.5) and a strongly positive anti-Ro antibody >600 U/ml (0-10). Differential diagnosis considered: ANCA associated vasculitis (AAV), Primary Sjögren’s syndrome (SS), and IgG4-related orbital disease. She was assessed by the ENT surgeon and there was no sinusitis or evidence of vasculitis. Chest X-ray and CT scan of chest were normal.A left lacrimal gland biopsy revealed reactive lymphoid hyperplasia with numerous plasma cells and eosinophils. Immunohistochemistry revealed over 50% of plasma cells to be IgG4-positive (approximately 100/HPF) suggestive of IgG4-RD. There was no evidence of granuloma formation or malignancy. Serum IgG4 was raised 6.82 g/l (<1.3). A review by ophthalmology revealed no objective evidence of dry eyes. She was treated as IgG4-RD and demonstrated a marked improvement following treatment with oral steroids and azathioprine.Case report - DiscussionIgG4-RD is an immune-mediated systemic fibro inflammatory disease characterised by tumefactive lesions with abundant IgG4-positive plasma cells infiltrating into multiple organs. Isolated IgG4-related ophthalmic disease is present in 23% of patients with IgG4-RD, in whom the lacrimal gland is the most commonly involved structure, followed by orbital fat and extraocular muscles. IgG4-related ophthalmic disease is rare and we need to exclude commoner causes of orbital inflammation (such as thyroid ophthalmopathy, granulomatosis with poly-angiitis, sarcoidosis, and tuberculosis) or malignancy.Case report - Key learning pointsThe diagnosis of IgG4-RD is often challenging. It is well recognised that small vessel vasculitis can increase the number of IgG4-positive plasma cells in tissue biopsies. Additionally, literature reveals biopsy-proven IgG4-RD can have ANCA positivity with and without concomitant presence of ANCA-associated vasculitis and there are case reports of patients who fulfil criteria for both Sjogren’s syndrome and IgG4-RD. As such, diagnosis requires careful correlation of clinical, radiologic and histological features due to the overlapping features in differential diagnoses.

Primary cutaneous angiosarcoma of the eyelid

A 67-year-old male, presented with the complaints of itchy, painless, rapidly enlarging black colored mass arising from his left upper eyelid. Ocular examination revealed a dark colored nodule with overlying crust on the temporal aspect of the left upper eyelid. An excisional biopsy revealed a well-circumscribed tumor composed of anastomosing vascular channels of varying sizes. Lining endothelial cells revealed focal areas of hypercellularity, mild to moderate pleiomorphism. Immunohistochemistry revealed that tumor cells are diffusely immunopositive for CD34. A diagnosis of primary cutaneous angiosarcoma of eyelid was made. Systemic oncological workup for metastatic disease was negative. The patient thereafter underwent wide surgical excision with frozen section control of margins followed by free flap skin graft under general anesthesia to achieve complete surgical resection of the tumor. Thus, although extremely rare, angiosarcoma of eyelid should be considered in the differential diagnosis of unusual or atypical eyelid lesions; the early diagnosis and treatment of which improves the survival rate.

Miastenia Gravis Okular Juvenil: Laporan Kasus

Abstract Purpose: This study aimed to summarize the general history, physical exam findings, confirmation test, and treatment of a patient with juvenile ocular myasthenia gravis. Research Methodology: This article is a pediatric RSUD Abdoel Moeloek Lampung case report in April 2021. The subject of the case is a 3-year-old girl who is hospitalized in the hospital ward with juvenile ocular myasthenia gravis. Result: A 3-year-old girl, an inpatient in the Pediatric Ward, RSUD Abdoel Moeloek Lampung, with complaints of decreased left upper eyelid since three months ago. On physical examination, there was ptosis of the left superior palpebra. Prostigmine test was performed on day 2 of treatment in patients with positive test results. The patient was clinically diagnosed with “Juvenile Ocular Myasthenia Gravis.” Management of the patient during treatment was the injection of methylprednisolone 10 mg/12 hours and neostigmine orally 2.5 mg/8 hours. Limitations: This case report is limited to juvenile ocular myasthenia gravis cases with a scarce number of cases and rare cases in children. Contribution: This case report can be helpful in medical education or used as a reference in making relevant case reports and can be applied in the hospital area when there are cases of juvenile ocular myasthenia gravis.

Kounis Syndrome: Correct Diagnosis Leads to Correct Treatment Approach

Kounis syndrome is defined by the occurrence of an acute coronary syndrome with conditions associated with mast cell activation, involving interrelated and interacting inflammatory cells, and including allergic or hypersensitivity and anaphylactic or anaphylactoid attacks. 34 years old gentleman with a history of young hypertension came with a complaint of wasp sting over his left eyelid. Post sting, he developed shortness of breath associated with sweating, palpitation however no shortness of breath. He was unconscious shortly after that. During the casualty review, the patient has cold and clammy peripheries with the swollen left eyelid. He is hypotensive and tachycardic. Respiratory and cardiovascular examination was unremarkable. Electrocardiography (ECG) showed ST depression over lead 1 and aVL with ST-elevation at lead V1-V3 and T inversion lead 1, aVL, V4 – V6. Repeated ECG showed evolving changes of ST-elevation over lead V1-V3. Troponin I, 3 hours post wasp sting was not elevated. The patient was given intravenous hydrocortisone, intramuscular adrenaline, antihistamine, and intravenous fluids challenge. Blood pressure normalized and repeated ECG showed resolved ST elevation changes. This patient fits the criteria for Kounis syndrome type 1 secondary to an anaphylactic reaction towards wasp sting. The ECG changes were attributed to the coronary artery vasospasm secondary to an anaphylactic reaction. Type 1 Kounis syndrome can happen with or without raised cardiac enzyme or troponin. It resolved by itself when proper medications were given to reverse the anaphylactic reaction. Early recognition of Kounis syndrome leads to correct treatment approach.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S13

A Case of Idiopathic Orbital Inflammation Presenting as Isolated Myositis of the Inferior Oblique Muscle

Purpose: To report a case of idiopathic orbital inflammation presenting with isolated myositis of the inferior oblique muscle. Case summary: A 54‐year‐old man presented with swelling on the left lower lid, pain on superonasal and inferonasal gaze, and binocular diplopia for 2 months. His head was tilted to the right by about 5° and mild conjunctival injection and 3 mm narrowing of palpebral fissure of the left eye compared to the other eye were observed. Eight prism diopter (PD) left hypertropia and 4 PD intermittent esotropia were noted on primary gaze, which worsened on leftward gaze, downward gaze, and left head tilt. Orbital magnetic resonance imaging (MRI) showed enhanced hypertrophy of the left inferior oblique muscle. Systemic work‐up for possible inflammatory diseases yielded negative results. Therefore, a presumptive diagnosis of idiopathic isolated myositis of the left inferior oblique muscle was made. The patient was treated with 60 mg of oral corticosteroid per day for the first week, and the dose was tapered for 1 month as the symptoms reduced. Two months later, the patient became free from any symptoms and follow-up orbital MRI showed a significant decrease in size of the left inferior oblique muscle. There have been no signs of recurrence for 7 months. Conclusions: A presumptive diagnosis of idiopathic isolated myositis of the inferior oblique muscle was made in a patient with swelling of the left lower lid and binocular diplopia based on orbital MRI and systemic work‐up. Good results were achieved with oral corticosteroid therapy.

What's in an Eye?

What's in an Eye?

Sequential Surgical Treatment for Congenital Monocular Elevation Deficiency and Exotropia: A Case Report

A 20-year-old lady presented with drooping of left upper eyelid since childhood. After detailed examination she was diagnosed to have congenital monocular elevation deficiency and exotropia in the left eye. Sequential surgical correction procedures were performed to treat her left eye condition i.e., first surgery to correct exotropia (recession and resection of the horizontal recti), second surgery to correct hypotropia (recession and resection of vertical recti) without Knapp’s or modified Knapp’s proceadure. Left eye was looking straight in primary position; however, there was hypertropia in the right eye. Third surgery was done to correct hypertropia in the right eye (recession and resection of vertical recti) following which both eyes were straight in primary position. Even though the patient has undergone surgery three times, she was very happy with good cosmetic results.

Re-evaluation of abusive head trauma in Norway appears flawed.

A review by Wester et al in Acta Paediatrica presented 17 adjudicated cases of Norwegian infants with abusive head trauma (AHT).(1) Their interpretation of the medical findings identified alternative diagnoses for 16 of the 17 children and suggested that the injuries were not inflicted and may have been the result of spontaneously occurring events. The authors stated that eight children had clinical and radiological characteristics consistent with external hydrocephalus, complicated by chronic subdural haematoma, and that six had findings compatible with hypoxic-ischaemic insults. Fractures were attributed to prematurity and sequelae from birth trauma. If their interpretations are correct, this study calls for a thorough review of how the medical community, forensic experts and the courts manage AHT cases. However, there are several elements of concern in the Wester et al study that we believe need clarification before a conclusion can be reached.

Eyelid Lipoma

Purpose: To report a rare case of eyelid lipoma. Case summary: A 41-year-old female presented with a palpable mass in her left upper eyelid. Diffuse hard mass was palpable at preaponeurotic fat layer of left upper eyelid, and there was no inflammatory sign. Under local anesthesia, a left upper eyelid mass partial excision was performed and a biopsy specimen was collected. The mass was yellower and harder than surrounding normal eyelid fat. A lipoma was diagnosed based on histopathological findings such as proliferation of mature adipocytes. Conclusions: Lipoma is a benign tumor commonly found around trunk and limbs, but rarely occurs at eyelid. Eyelid lipoma should be considered as a differential diagnosis of diffuse mass at eyelid fat layer. Diagnosis and treatment can be achieved by partial excision and histopathological examination.

An unusual presentation of well-differentiated squamous cell carcinoma of left upper eyelid: Case report

Squamous cell carcinoma is mainly an invasive epithelial malignancy having keratinocyte differentiation. They are relatively rare and usually slow growing skin cancer. Well-differentiated squamous cell carcinoma closely resembles normal epithelial cell. We report a case of a sixty-five-year-old female who presented to the ophthalmology outpatient department with the chief complaint of a rapidly growing mass on her left upper eyelid for 6 months interfering with her vision. Physical examination revealed a firm mass of size 3.5 cm x 3 cm x 2.5 cm. RT-PCR for COVID-19 was done and found negative. Routine blood investigations, blood sugar levels, viral serology, chest X-ray were done. Excision and biopsy with wide margins at the base were performed under local anesthesia. Histopathological examination of the specimen showed well differentiated squamous cell carcinoma. The patient responded satisfactorily. Early diagnosis and treatment reduce the morbidity and mortality of the patient.

Hypercalcemia of malignancy in metastatic adenocarcinoma of left lower eyelid - A report of a rare case

Adenocarcinoma of eyelid is a rare disease with an incidence of 1 to 5.5% and is considered to be the most common eyelid malignancy following basal cell and squamous cell carcinoma. The symptoms usually present as swelling, thickening, change in appearance of the eyelid skin and ulceration. Various treatment modalities include surgery, radiation or chemotherapy relying upon the stage of tumor at the time of presentation. However, metastasis of adenocarcinoma of the eyelid to other organs is quite rare. We are presenting a case of a 35 year old male who initially presented with complaints of watering in the left eye and in due course, was diagnosed with adenocarcinoma of eyelid which was being treated and eventually progressed to lung and skeletal tissues. This gentleman also had severe Hypercalcemia which was secondary to paraneoplastic syndrome.