Left Eyelid Research Articles

Malignant appearing benign lid tumor – An isolated upper lid schwannoma

Sebaceous carcinoma is notorious for masquerading as other benign and malignant lesions. A 50-year-old male presented with a painless mass on the lateral aspect of the right upper lid. On examination, there was a 25 mm ××× 20 mm ×× 14 mm, nontender, well-defined, nodular mass hanging from the lateral aspect of the left upper lid with loss of lid margin architecture, and lashes locally. A differential diagnosis of sebaceous cell carcinoma was made. He was taken up for excision biopsy with frozen section control of margins which to our surprise revealed a spindle cell tumor with no signs of malignancy. Later on detailed histopathological examination and immunohistology of excised mass, a diagnosis of schwannoma of eyelid was reached. It is, therefore, better to err on the side of caution, diagnosing, and managing such dubious tumors vigilantly. Schwannomas thought very rare, should be kept in mind as a differential of the upper eyelid tumors.

Familial Marcus Gunn Phenomenon Without Ptosis in Resting Position in 2 Successive Generations: A Case Report and Review of Literature

BACKGROUND Marcus Gunn Syndrome is a rare congenital disorder. The major symptoms are congenital ptosis and the synkinetic movement of the affected eyelid mandibular movements, cases with the absence of the ptosis symptom, even rarer, were also recorded. The aim of this article was to present 2 cases of Familial Marcus Gunn Jaw-Winking Synkinesis (MGJWS) without ptosis in resting position in two successive generations. CASE PRESENTATION Upon routine examination, the 41-year-old female patient was diagnosed with MGJWS, with the synkinetic movement of the upper left eyelid only observed during the downward, forward, and lateral mandibular movements. Ptosis wasn't observed in the resting position. The patient's 12-year-old daughter, who didn't have any significant medical history, was also diagnosed with MGJWS, with the same symptoms. No surgical or conservative intervention was performed on the patients and they are currently under regular follow-up. CONCLUSION The synkinetic movement being observed during masticatory movements presents a diagnostic opportunity for the dental clinician and surgeon, since it will be observed during a routine examination. Thus the authors think that it's important for dental clinicians and surgeons to be informed about the syndrome. To the best of our knowledge, our study is the first clinical case study of MGJWS without ptosis in resting position observed in two successive generations.

Kombinasi Injeksi Triamsinolon Asetat Intralesi dan Propanolol Oral pada Kasus Hemangioma Kapiler Palpebra

Capillary hemangioma is a benign tumor developed from the abnormal proliferation of blood vessels. This tumor appears on eyelids and orbit. Around 75% of hemangioma resolves spontaneously in the first 4-5 years of life. Intervention is needed in hemangioma that obstructs the visual axis. It has been reported that a two-year-old girl came to Polyclinic with a mass on the left superior eyelid 1,5 years ago. At first, the left superior eyelid looked puffy, then developed slowly until it covered the left eye. On the examination of the left eye, visual acuity assessment was hard to perform. Mass in superior palpebral was 8mm x 8mm x 8mm, reddish colored (different with adjacent skin), consistency supple, mobile, painful (-), edema (+), horizontal palpebral fissure (FPH) 30 mm, vertical palpebral fissure (FPV) 0 mm. CT scan showed suspected hemangioma. The patient was diagnosed with capillary hemangioma and given an injection of triamcinolone acetate intralesional and oral propranolol under the supervision of a pediatrician. Significant clinical improvement was observed after 40 days of injection, where the mass was resolved completely. The FPV and FPH of the left eye had improved to 9 mm and 30 mm, respectively, with the patient finally able to follow the object. The combination of intralesional triamcinolone acetate and oral propranolol in this case is quite effective in providing complete resolution of capillary hemangioma.Keywords: capillary hemangioma, triamcinolone acetate injection, propanolol

Human palpebral infestation by mysterious laying eggs: A case report

AbstractPurpose: Tick infestation of ocular tissues is a rare occurrence. Ticks are ectoparasites which feed with animal blood. They are vectors of several diseases, as Lyme borreliosis, Crimean‐Congo hemorrhagic fever, typhus, Q fever,... We present the case of a tick infestation of the eyelid of a child.Methods: A 7‐year‐old girl presented for itchy eyelid, pain, and sensation of moving worms in the left superior eyelid. Her mother reported they just came back from vacation in Thailand, 3 days before. Examination of the left upper lid revealed one large moving ectoparasite with a group of eggs, laid below the upper eyelid. Some eggs had hatched, and small ticks were moving on and under the upper eyelid. Given the age of the girl and the nature of the infestation, it was impossible to remove the parasite and eggs at slit lamp. An appointment was settled the next day to remove them in operating room. The following day, the parasite detached itself from the eyelid. The sample was sent to a specialized center in tropical species. Careful examination revealed a slightly swollen palpebral conjunctiva towards the area where the tick was. Physical examination did not reveal other ectoparasite and treatment with Tobramycine was initiated as a precaution. The girl was sent to infectious diseases specialist to perform serologic tests.Results: The ectoparasite was identified as amblyomma sp tick. A shell insect infestation on the eyelid is not common at all. The cases found in literature describe cases of ticks feeding on the eyelid, but none of them reports the presence of eggs around the large ectoparasite (1). We supposed that the parasite stayed long enough to lay its eggs.Conclusions: Ophthalmologists are rarely confronted with ectoparasites and should be aware that removing the whole tick from the affected tissue is of important in the prevention of tickborne diseases and possible local complications (2). Serologic tests for tick‐borne diseases should be done and the patient monitored with clinical observation and follow‐up.

Management of Adnexa Foreign Body: A Piece of Mica from a Broken Helmet

Introduction: Adnexa foreign body is one of the classifications of extraocular foreign body. Visual prognosis depends on the zone of injury, type, and size of the foreign body and subsequent complications. Case presentation: A 5-year-old girl came to the outpatient clinic with her parent with chief complaints of swelling and pain in the left lower eyelid after a motorcycle accident five months ago. The patient was hit by a piece of mica from a broken helmet in her left eye. The patient complained that her left eye was red, swollen, and difficult to be opened. She was referred to one of the ophthalmologists in Jember and then referred to Dr. Soetomo Hospital for the diagnosis of a conjunctival tumor in the left eye. The visual acuity of both eyes was 5/5. There was conjunctival hyperemia and a foreign body of glass or mica in the inferior fornix. CT scan imaging revealed corpus alienum with the size of 1.05 x 0.5 x 2.1 cm in the subcutan of the left inferior eyelid and ciliary body with swollen tissue around the corpus alienum. The patient was planning to extract the foreign body. Discussion: Definitive management was surgical. Corpus alienum extraction depends on the composition and size of the object. Adnexa foreign body management in the fornix was challenging because of the narrowing of the operating space. It was essential to identify the material type of the foreign body and the mechanism of injury because it impacts the step of the technique. Conclusion: Adnexa foreign body is one of the emergency cases in ophthalmology. The extraction technique depends on the object's composition and size because it impacts the step of the operation technique.

Neonatal eyelid penetration from insertion of a fetal scalp electrode: a case report

BackgroundA fetal scalp electrode (FSE), first described by Edward Hon in 1967, is an intrapartum monitoring device embedded directly into the fetal scalp for an accurate measure of fetal heart rate. Though use of an FSE is generally safe, complications can occur from misplacement, including ophthalmic injury.Case presentationPatient was a 28-year-old G6P5006 who presented for induction of labor at 39 weeks due to asymptomatic bilateral pulmonary embolism. Concerning findings on external fetal monitoring led to placement of a fetal scalp electrode for close monitoring. Upon delivery, the neonate was noted to have the FSE embedded in the left upper eyelid. Ophthalmology was consulted and could not rule out ocular injury on external examination at the bedside. Examination under anesthesia in the operating room demonstrated no penetration of the ocular globe, and the eyelid laceration was sutured. The laceration was well-healing at one-week follow-up with no further complications.ConclusionFacial or brow presentation during delivery is rare but may increase the risk for misplacement of an FSE. Ultrasound verification of vertex position is warranted immediately prior to placing an FSE for patients at higher risk of facial or brow presentation. Periorbital edema of neonates may protect against damage to deeper structures. However, Ophthalmology should be consulted to rule out ocular injury if the FSE is placed in the periocular region.

Orbital apex syndrome secondary to osteomyelitis of maxilla following dental caries

To report a case of unilateral orbital apex syndrome with periorbital abscess secondary to osteomyelitis of maxilla following right upper molar dental cariesA 37 years old female patient presented with fever and toothache 1 month ago treated in a local hospital following which she developed facial swelling, dropping of left eyelid and sudden, progressive diminution of vision in left eye. Patient underwent tooth extraction following which facial swelling worsened. She was newly diagnosed as diabetic. Visual acuity in Right eye was 6/6 and in Left eye was PL negative. Detailed Slit lamp examination, fundus examination and cranial nerve examination was done. CT and MRI scan was done.This case highlights the importance of early diagnosis and timely management of dental caries to prevent dreaded complications like orbital apex and cavernous sinus involvement.

Comprehensive Management of Preseptal Cellulitis with Massive Palpebral Abscess in 72-year-old Man

Introduction: Infectious inflammation of the periorbital and orbital soft tissue can be classified as preseptal (periorbital) or postseptal (orbital) cellulitis. Eyelid abscess, an accumulation of pus in the palpebral tissue, can occur in isolation or in association with preseptal cellulitis. Preseptal cellulitis is nearly three times more common than orbital cellulitis. Case Presentation: The patient, in this case, was admitted with a complaint of swollen left eyelid ten days before being admitted. Swollen eyelid with the inability to open the left eye was accompanied by pus discharge five days before coming to the hospital. Current complaints include eyelid pain, swelling, and discharge of thick yellow fluid. Massive abscess with active pus and crust was present in the left superior and inferior eyelid and frontotemporal area. A head CT scan revealed a soft tissue mass in the left sub galea soft tissue, left frontal region, left orbit, and left temporal region. Multi-department consultations and several workups were done to reveal the etiology and plan the appropriate management of this condition. Conclusion: A comprehensive assessment must be done to distinguish preseptal and orbital cellulitis. Ophthalmology examination and imaging are crucial to detect any extension of the palpebral abscess beyond the orbital septum. Examining an immunocompromised state and focal infection is crucial in determining proper treatment.

UNUSUAL CAUSE OF PERIORBITAL ANGIOEDEMA.

<h3>Introduction</h3> We present a case of eyelid edema initially thought to be due to allergic conjunctivitis, angioedema and periorbital cellulitis that was eventually discovered to be due to Immunoglobulin G4-related disease (IgG4-RD). <h3>Case Description</h3> Our patient was a 57 year-old female with asthma and allergic rhinosinusitis, who presented to clinic with right eyelid edema, injected conjunctiva, and pruritus. She had a history of left eyelid swelling attributed to meibomian gland dysfunction. Initially we treated her for allergic conjunctivitis. A year later, she was treated with clindamycin for periorbital cellulitis, and the year after that, treated for angioedema by the emergency department. Soon after, she developed left eyelid swelling and thick eye discharge. Neuro-ophthalmology evaluation was concerning for polyclonal lymphoid proliferation and sclerosing orbital pseudotumor. Serum IgG4 was elevated and a lacrimal gland biopsy revealed reactive lymphoid hyperplasia compatible with IgG4-RD. She was treated with prednisone for several weeks with good response. <h3>Discussion</h3> IgG4-RD is an uncommon medical condition that can present similarly to more common diseases and can be challenging to diagnose.

Trichoblastoma of the Lower Eyelid

Purpose: We report an unusual trichoblastoma of the lower eyelid.Case summary: A 74-year-old male presented with an asymptomatic 0.6 × 0.4-cm left lower eyelid tumor that had developed 3 years prior. On histological examination, a 0.3 × 0.3-cm intradermal tumor that was not connected to the epidermis was observed. The tumor was multilobular, and was surrounded by fibrous stroma and connective tissue. The tumor lobules consisted of basaloid cells, and a few keratinizing cysts were evident. These features are consistent with a trichoblastoma. We observed no recurrence at 1 year after complete resection.Conclusions: Trichoblastoma (a rare, benign skin tumor) is histologically similar to basal cell carcinoma but the prognosis is excellent after complete resection. Trichoblastoma should be considered during the differential diagnosis of basal cell carcinoma of the eyelids.

GUILLAIN-BARRÉ SYNDROME AND COVID-19 VACCINATION: A DISCONCERTING ASSOCIATION

Guillain-Barré syndrome (GBS) is an acute, inflammatory peripheral nerve disorder characterized by rapidly progressive, ascending, symmetrical paresthesia, and motor weakness. Some patients may develop respiratory failure requiring ventilation. The annual incidence of GBS is ~1.7 persons per 100,000 population. We describe the case of a 61-year-old male complaining of headache, one episode of vomiting, giddiness, slight slurring of speech, and inability to close his left eyelid. The patient received intravenous immunoglobulin therapy, with improvement in his symptoms at the time of discharge. In addition, we have also summarized 41 cases of GBS reported on post-COVID-19 vaccination. The intention of this case report is to highlight on the incidence of GBS in individuals who have received COVID-19 vaccine. Moreover, physicians should be aware of GBS in every patient presenting with neurological complaints on OPD.

Case Report on Unilateral Right Acoustic Schwannoma operated for open decompression craniotomy

Background: A benign tumor known as an acoustic neuroma can form on the auditory nerves that connect the inner ear to the brain and control balance and hearing. Hearing loss and unbalance could result from the tumor's pressure on the nerve. Case presentation: A 52 years old female patient came to the medicine outpatient department with the chief complaint of headache for 8 days and vertigo while walking for 10 days then she develops a hearing loss in the right ear and later imbalance while walking in the previous month. She had a history of accidental injury to the left eyelid, eyebrow, and left cheek. Firstly, computed tomography (CT) scan has been done and after that magnetic Resonance Imaging (MRI) was advised to the patient. Currently, she is operated on for open decompression craniotomy where excision of the tumor was done under general anesthesia after obtaining physical fitness for surgery. Afterward, she was treated with antibiotics, analgesics, and anti-inflammatory medicines, and post-surgery CT was done. Conclusion: Schwann cells that surround the vestibular nerve, typically in the internal auditory canal, can give rise to benign tumors called acoustic schwannomas. Although the findings on CT and MRI were unusual for acoustic schwannomas, minor acoustic schwannomas might also be found and removed during surgery in addition to the huge cysts.

Ayurvedic management of Vartma sthambha (ptosis) with Panchakarma (bio purificatory measures) and Netrakriyakalpa (ocular therapies)

This is to report a case of ophthalmoplegia developed after transsphenoidal surgery for pituitary adenoma, which was treated effectively with Ayurvedic Panchakarma (~bio purificatory measures) and Netrakriyakalpa (~ocular therapeutic procedures). Ophthalmoplegia refers to paralysis of both extrinsic and intrinsic muscles of the eyes. It is an uncommon complication after transsphenoidal surgery for pituitary adenoma and recovers spontaneously in most of the cases. If not resolved even after 6-12 months, surgery is done to correct the squint and ptosis. In this case, as the patient was apprehensive about surgery, Ayurvedic Panchakarma and Netrakriyakalpa procedures were prescribed. An Indian female aged 69 years reported with drooping of the left upper eyelid, deviation, and restricted eye movements in the left eye, and double vision for one year. It was a diagnosed case of postsurgical ophthalmoplegia due to third (oculomotor) and sixth (abducens) cranial nerve palsy. She was administered Panchakarma and Netrakriyakalpa. Oral medicines, Dhanadanayanadi kashaya and Ekangavira rasa, were prescribed for one month. After treatment, there was a remarkable improvement in ptosis. However, squint, restricted eye movements, and diplopia persisted. Ayurveda treatment, including Panchakarma and Netrakriyakalpa, is safe and effective in managing postsurgical ptosis, especially in patients who are apprehensive about surgery. This treatment plan could be further tried in ptosis of other etiologies as well. In Ayurveda, treating squint, restricted eye movements, and diplopia is challenging, and further research needs to be done.

Neonatal Scrub Typhus with an Eyelid Eschar Masquerading as “Late-onset Sepsis”

Background: Scrub typhus is a mite-borne infection caused by the bacterium, Orientia tsutsugamushi. It is re-emerging in many parts of South East Asia, particularly in rural India. Although no age group is immune to this infection, scrub typhus in neonates is rarely suspected and reported. Here, we report a neonate with scrub typhus who was initially misdiagnosed as “late-onset neonatal sepsis.” Clinical Description: A 26-day-old exclusively breastfed infant presented with fever, vomiting, loose stools, abdominal distension, and refusal of feeds for 3 days. Examination revealed an irritable, febrile, and pale infant. She had tachycardia and facial puffiness. On abdominal examination, generalized distension with hepatosplenomegaly was noted. Blood investigations were suggestive of lymphocytic leukocytosis, thrombocytopenia, toxic granules in peripheral smear, and elevated C-reactive protein. Management: The infant was promptly started on empirical antibiotics for “late-onset sepsis.” However, in view of poor response, other possible differential diagnoses were considered. Careful reexamination revealed a necrotic ulcer covered by a yellow scab with erythematous rim on the left lower eyelid. Based on the clinical presentation and an eschar-like lesion, scrub typhus was suspected. The neonate was started on oral azithromycin and immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) testing for scrub typhus came back positive. Fever subsided immediately within 48 h and the infant was discharged after 7 days. Conclusion: Acute febrile illness due to scrub typhus can affect newborns. A high index of suspicion is required for early diagnosis. Timely treatment leads to prompt clinical response and reduced complications.

Demodicosis

A 75-year-old female presented with swelling and redness on the left lower lid away from the lid margin since 10 days. The best corrected visual acuity in both eyes is 6/6 and N6. On examination, an erythematous ulcerative lesion with rolled edges and central necrosis on the left malar area was seen clinically mimicking basal cell carcinoma. Excision biopsy was performed, and the histopathology report revealed an inflamed follicle with intra-follicular demodex folliculorum with ulceration and suppurative abscess with necrotizing destruction of hair follicles. The patient was treated with topical ciprofloxacin ointment. Follow-up after 3 weeks showed complete resolution of the lesion with no recurrence at 3 months.

ATYPICAL PRESENTATION OF MUCORMYCOSIS IN A NONSEVERE COVID-19 PATIENT

ATYPICAL PRESENTATION OF MUCORMYCOSIS IN A NONSEVERE COVID-19 PATIENT

UNILATERAL PTOSIS AS A FIRST MANIFESTATION OF SARCOIDOSIS

UNILATERAL PTOSIS AS A FIRST MANIFESTATION OF SARCOIDOSIS

A Rare Case of Pachydermoperisotosis (PDP) and Its Ocular Manifestations

A case of 56 yearsold Pakistani male visited OPD with complaint of thickening of both eyelids, ptosis and left lower lid ectropion caused by rare condition named pachydermoperiostosis (PDP). PDP is a rare autosomal dominant condition but autosomal recessive families probably can also occur. It is manifested by clubbing of digits, hyperhidrosis of palm and feet, peri-ostosis, acro-osteolysis and pachydermia. Ocular features include blepharoptosis, floppy eyelids, eyelid and palpebral conjunctival hypertrophy, mechanical ectropion, meibomian gland dysfunction, tear film abnormalities, punctate epithelial erosions and ocular surface disease. Surgical management was given by full-thickness wedge resection leading to horizontal tightening and this was done along with shortening of levator and its advancement. Histopathology demonstrated chronic non-specific inflammation and foreign body giant cell reaction.

Individualised homoeopathic treatment for a longstanding meibomian cyst: A case report

A chalazion is a chronic sterile lipogranuloma. They are typically slowly enlarging and non-tender. A deep chalazion is caused by inflammation of a tarsal meibomian gland, while a superficial chalazion is caused by inflammation of a Zeis gland. A 4-year-old child was brought for homoeopathic treatment of a meibomian cyst of the left upper eyelid with the hope to avoid surgical intervention. After full case taking, case analysis and proper individualisation, a single homoeopathic medicine was prescribed. After 2 months of treatment, the child was relieved of her presenting symptoms and showed general improvement in health. This article provides a clinically useful review of a case with evidence about how an individualised homoeopathic medicine treated a likely surgical case successfully.

Primary epithelioid hemangioendothelioma of the eyelid: A case report

Eyelid epithelioid hemangioendothelioma (EHE) is uncommon. The present study reports the clinical, histopathological and immunohistochemical characteristics of a 10-year-old girl with EHE and reviews the related literature. The patient was admitted with a painless red mass on the left eyelid, which had been present for 6 months. Under the microscope, tumor cells from the surgical specimen were composed of epithelioid cells (70%) and spindle cells (30%). The cytoplasm was eosinophilic, and some areas of the cytoplasm showed signet ring-like or vacuolization changes. The presence of red blood cells could be seen in the luminal part of the primary blood vessel. Immunohistochemical results showed that the tumor cells were positive for CD34 and CD31, and the Ki-67 proliferation index was 3%. As the first resection margin was positive, recurrence occurred 3 months after surgery, Therefore, patients with such tumors should undergo full resections to ensure a negative margin to prevent recurrence.