Unilateral Eyelid Research Articles

Delayed unilateral eyelid oedema following non-periocular hyaluronic acid injection: A case report and literature review

Delayed unilateral eyelid oedema following non-periocular hyaluronic acid injection: A case report and literature review

The central and peripheral corneal response to short-term hypoxia.

To quantify the magnitude and recovery of central and limbal corneal oedema induced by short-term unilateral eyelid closure without contact lens wear. The left eye of 10 adults with healthy corneas was patched using a folded eye pad for 30 min. High-resolution optical coherence tomography images (which captured the limbal and central corneal regions simultaneously) were obtained before patching, immediately after eye opening and again at 1, 2, 5, 6, 9, 10, 14 and 15 mins after eyelid opening. Oedema was measured from the limbus (scleral spur) to the central cornea (thinnest corneal location) along the horizontal meridian. A greater amount of limbal oedema was noted (mean [SD] 3.84 [1.79] %) compared to the central cornea (2.48 [0.61] %; p = 0.04) after 30 mins of unilateral eyelid closure. Both central and limbal corneal oedema recovered rapidly following eyelid opening, with no significant differences in the rate of corneal recovery between corneal locations (p = 0.90). Short-term unilateral eyelid closure resulted in ~55% more relative oedema in the limbal region compared to the central cornea. Rapid recovery of oedema and corneal overshoot (thinning beyond the baseline corneal thickness) was observed within 1-2 min of eyelid opening for both central and peripheral regions.

Correlation between extraocular muscle enlargement and thyroid autoantibodies in thyroid eye disease

PurposeThis study aimed to investigate the factors affecting extraocular muscle enlargement in thyroid eye disease (TED).Study designRetrospective study.MethodsThe thyroid-stimulating hormone (TSH) receptor antibody (TRAb), thyroid-stimulating antibody (TSAb), antithyroid peroxidase antibody (ATPO), and antithyroglobulin antibody (ATG) levels in patients diagnosed with TED who underwent orbital magnetic resonance imaging were assessed. The control group comprised the contralateral eye of patients who underwent orbital magnetic resonance imaging (MRI) for unilateral eyelid tumors or orbital disease. The thickness of the bilateral rectus muscles and superior oblique muscles was measured on orbital MRI. Muscle enlargement was classified as unilateral/bilateral and symmetric/asymmetric. The effects of age, sex, smoking history, TSH, thyroid hormone, and thyroid autoantibodies on the muscle thickness and number of enlarged muscles were assessed by use of simple and multiple regression analyses.ResultsThe TED and control groups comprised 41 and 44 cases, respectively. The positivity rate of TSAb in patients with TED was 92.7% higher than that of the other autoantibodies. Muscle enlargement was observed in 29 of the 41 cases (70.7%). Older age and higher TSAb levels were identified as significant factors affecting the total muscle thickness and number of enlarged muscles. Bilateral muscle enlargement and asymmetrical muscle enlargement were observed in 17 (58.6%) and 23 (79.3%) of the 29 cases, respectively. The TSAb levels and age had no significant effect on the type of muscle enlargement.ConclusionsTSAb showed significant associations with extraocular muscle enlargement. Measurement of TSAb, rather than of TRAb, may be more useful for diagnosing extraocular muscle enlargement in patients with TED.

Clinical Feature of Langerhans Cell Histiocytosis of the Orbit : A First Case Series in Indonesia

Introduction : Langer hans histiocytosis (LCH) is an inexplicable disease characterized by proliferation of Langerhans and intermixed with inflammatory cell, in particular eosinophil, which represents only 1% pediatric orbital tumours. Orbital involvement of LCH is a rare clinical entity as the disease simulate variety of malignancies and present as a diagnostic and management dilemma for ophthalmologist.
 Case Illustration : Two cases of toddler presented with unilateral progressive upper eyelid swelling and proptosis for more than a month. Both cases has history of orbital trauma 1 month before swelling was observed. Initial CT scan revealed extraconal mass, with destruction of lateral orbital wall and frontal bone. Both patients had histopathological biopsy confirmed eosinophlic cytoplasm. One patient confirmed immunohistochemistry markers S100 and CD1a which is specific for Langerhans cells. Both patients continue with chemotherapy as definitive treatment.
 Discussion : LCH is a wide clinical spectrum which manifestation simulate other pediatric orbital malignancies. Case illustration present unilateral eyelid swelling with history of trauma may resemble other diagnosis unless further work up is performed. This case series exhibits clinical manifestations that may be suggestive of LCH. Considering rapid progression of disease, definitive diagnosis is a mandatory based on histopatological analysis through biopsy surgery.
 Conclusion : LCH is rare disease, it should be considered as one of deferential diagnosis in pediatric orbital malignancy with initial presentation acute unilateral eyelid swelling, proptosis, history of trauma, extraconal mass and destruction of bones as radiological features. This might be helpful for early recognition and prompt treatment of disease suggestive of LCH.

Ocular Metastasis from Breast Carcinoma: A Case Report

Background: Eye metastases are a rare event in cancer, patients with breast cancer being the most common primary site (28.5%–58.8%). Patients with ocular metastatic disease can present with a variable clinical picture. Most often presents as a cutaneous or subcutaneous nodule simulating a chalazion but with rapid growth and possible superficial ulceration. The definitive diagnosis is based on the anatomopathological analysis of the lesion. The treatment remains palliative and the prognosis remains poor. Objectives: To further define the histopathologic features of breast carcinoma conducive to orbital metastasis. Methods: We report a case of ocular metastasis in a 46-year-old woman presenting with right eye pain. She had been treated for ductal carcinoma breast cancer with lymph node and bone metastases 5 years ago; a mastectomy with lymph node dissection was performed. The patient consults us for unilateral eyelid swellings evolving for 4 months. On examination, we find well-limited rounded tissue formation in the right upper eyelid ulcerated in places. Oculomotricity was preserved and the rest of the examination was unremarkable. A biopsy of the lesion was carried. Results & Conclusions: Microscopic examination revealed a fibrofatty tissue seat of a tumoral proliferation made of spans and cords, of carcinomatous cells with moderate atypia showing some mitosis figures. The stroma is fibrous. Immunohistochemical studies showed positive immunoreactivity to pancytokeratin, estrogen receptor, progesterone receptor and HER-2, the results were in favor of a metastatic breast carcinoma. In summary, In the case of a metastatic orbital tumor, breast cancer should be considered as a possible source, especially in elderly women. Integrating the clinical information with histopathological findings is warranted.

Mite Bite Underlying A Lid Swelling - A Rare Presentation Of Scrub Typhus

Scrub Typhus, a vector-borne and zoonotic disease by Orientia tsutsugamushi, is one of the causes of acute febrileillness in India. In endemic regions where Scrub Typhus is prevalent, healthcare providers should keep an eye out and be verysuspicious about this disease, especially when encountering patients with acute febrile illness and exposure to mite-infested areas.Prompt recognition and appropriate diagnostic testing, such as serological assays or molecular methods, are essential for accuratediagnosis. Once diagnosed, treatment with appropriate antibiotics, such as doxycycline or azithromycin, can effectively manageScrub Typhus and prevent complications. Early initiation of treatment is crucial to reduce the chance of severe disease and potentialmortality. This case report highlights the importance of considering Scrub Typhus as a potential differential diagnosis in lid infectionsand acute febrile illnesses, particularly in areas where the disease is endemic. Healthcare providers should be aware of the diverseclinical presentations and remain vigilant to ensure timely and accurate diagnosis, leading to appropriate management and improvedpatient outcomes. Public health efforts should also focus on increasing awareness about Scrub Typhus, its prevention, and earlydetection to minimize the burden of this often underdiagnosed disease. In this case report, we presented a child with febrile illnessand unilateral lid swelling misdiagnosed as stye. The presence of eschar prompted an investigation of Scrub typhus, which waspositive. This case is reported as the lid is an unusual site for eschar formation. To reiterate, scrub typhus should be considered adifferential diagnosis in lid infections and acute febrile illness, particularly in endemic areas.

Influence of unilateral eyelid spasms and botulinum toxin treatment on intraocular pressure measured by transpalpebral tonometer.

Eyelid spasms might be associated with elevated intraocular pressure (IOP) in hemifacial spasm (HFS) patients. IOP assessment using a Goldmann applanation tonometer (GAT) is often compromised by eyelid spasms. This study aimed to assess the effect of HFS on IOP measurements using the transpalpebral tonometer Diaton® before and after treatment with botulinum toxin type A (BTX-A) and compared Diaton® and GAT measurements after treatment with BTX-A. IOP measurements were obtained with Diaton® in 27 patients with moderate-to-severe HFS before and after treatment with BTX-A. After treatment, the IOP was also measured using GAT and the results were compared with the ones measured with a Diaton®. The patients underwent automated perimetry, OCT, and pachymetry for screening to glaucoma. Mean IOP with Diaton® was 11 ± 3.42mmHg before treatment in the affected eye and 9 ± 2.98mmHg in the contralateral eye. This difference was statistically significant (P = 0.012). However, after treatment with BTX-A, no interocular difference was found in IOP obtained with Diaton® (P = 0.204) or GAT (P = 0.971). Comparison between GAT and Diaton® measurements showed no significant differences after BTX-A treatment between the affected (P = 0.212) and contralateral eye (P = 0.971). A significant reduction in IOP measurements on the affected side of HFS patients was observed after treatment with BTX-A, demonstrating that eyelid spasms may increase the IOP. No significant difference was observed between Diaton® and GAT measurements after the application of BTX-A. No differences were found in automated perimetry, OCT, and CCT when comparing affected eyes with contralateral eyes.

Unilateral Eyelid Swelling Secondary to Local Palpebral Conjunctival Amyloidosis in a Young Patient

Purpose: We report a young patient with unilateral eyelid swelling secondary to local, palpebral conjunctival amyloidosis.Case summary: A 31-year-old male was referred with a 6-month history of mild, right upper eyelid swelling but without redness or tenderness. Slit-lamp examination revealed a diffuse hemorrhagic papilliform lesion on the right upper palpebral conjunctiva, this raised a suspicion of giant papillary conjunctivitis. As the lesion was unilateral, there was no history of allergic disease or contact lens use, and the lesion was refractory to topical anti-inflammatory treatment so, excisional biopsy of the right upper palpebral conjunctiva was performed. During the operation, the papilliform lesion was removed, it peeled off on the blade. After surgery, the eyelid swelling improved. Histopathological examination revealed an eosinophilic amorphous deposit consistent with amyloidosis. Further evaluation ruled out systemic amyloidosis; there were no abnormal findings. Thus, we diagnosed primary localized amyloidosis of the palpebral conjunctiva. At the 1-year follow-up, no recurrence was detected.Conclusions: Although primary localized amyloidosis of the palpebral conjunctiva is rare, this should be considered if chronic eyelid swelling accompanied by another conjunctival lesion such as giant papillary conjunctivitis is encountered.

Correction of Sunken Upper Eyelid in Asian Blepharoplasty Based on Anatomical and Histological Study of Orbital Fat Fascia Flap.

To explore the clinical application of orbital fat fascia flap in the correction of sunken upper eyelid in Asian blepharoplasty based on anatomical and histological research. Observe the histological structure of the orbital fat and its fascia vascularity through cadaver anatomy and histological sections of 10 cadavers. Based on the anatomical and histological characteristics of orbital fat, 36 patients with mild to moderate sunken upper eyelids were corrected by transposition of orbital fat fascia flap with preservation of fascia vascular pedicle. During the operation, the lateral part of the central cellulite of orbital fat was separated longitudinally and transferred to the sunken place to correct the sunken upper eyelid. Anatomy and histology show that the orbital fat was located between the anterior layer of the levator aponeurosis and the posterior layer of the orbital septum and was separated into fat lobules by many fibrous septa. The blood vessels move forward from back to front along the orbital fat interlobular septum, and the blood vessels in the capsule below the orbital fat are abundant. Clinical results showed that the shape of the sunken upper eyelid was significantly improved in 35 cases after correction with this method during the postoperative follow-up from 9 months to 18 months. The mean sunken depth improved from 6.2mm (±1.0 mm) preoperatively to 2.2mm (±0.9 mm) at the last follow-up with a statistical significance. And only 1 case had partial depression in the unilateral eyelid and received autologous granular fat transplantation with satisfactory postoperative results. The transposition of orbital fat fascia flap with longitudinal separation and preservation of fascia vascular pedicle can better correct the sunken upper eyelid during blepharoplasty, and the long-term effect is stable, which is worthy of clinical promotion. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Unilateral Eyelid Angioedema: An Atypical Manifestation in Childhood IgA Vasculitis

Immunoglobulin A (IgA) vasculitis (Henoch–Schönlein purpura) is an immune-mediated small vessel vasculitis, in which edema of the nondependent areas of the body, including the face and scalp is a rare cutaneous finding, found mostly in children <2 years of age. We report a case of a 7-year-old girl presenting with unilateral eyelid angioedema as a manifestation of IgA vasculitis. Early diagnosis and treatment are necessary, as the risk of renal complications increases with the incidence of angioedema.

Unilateral eyelid itching with eyelash loss after travelling.

Tinea blepharitis is a rare dermatophyte infection. The characteristic broken eyelash is an important diagnostic clue by trichoscopy or slit lamp examination. Other clinical clues suggesting dermatophytosis include pruritic scaly annular erythema and a history of recent contact with pets.

Amyopathic Dermatomyositis Manifesting With Marked Unilateral Eyelid Swelling and Hyperpigmentation in a Darker Skin Tone

A 56-year-old man presented to the emergency department with unilateral eyelid swelling, a hyperpigmented rash, and no myositis. His physical examination showcases the variable presentation of classic dermatomyositis skin manifestations in darker skin. Dermatomyositis is an uncommon disease characterized by proximal muscle weakness and classic dermatologic manifestations. In amyopathic disease, the diagnosis relies on the identification of dermatologic findings, in which variation in manifestations can lead to delays in diagnosis and increased health disparities.

Pronounced unilateral eyelid edema secondary to hypoalbuminaemia

Pronounced unilateral eyelid edema secondary to hypoalbuminaemia

Rare adverse effects of Electro Convulsive Therapy

IntroductionECT’s most common side effects are headache, memory impairment, and cardiovascular changes [1]. We report the unusual case of unilateral eyelid swelling and cheek flushing as a side effect of ECT in a depressed but otherwise healthy patient.ObjectivesThe patient is a 53-year-old woman with a recurrent depressive disorder for 15 years with a current major depressive episode without psychotic symptoms. With therapy resistance to mirtazapine (60 mg/d) and lithium (675 mg/d; 0.75 mmol/l), an ECT series with a total of seven sessions were performed. Treatment was performed with right unilateral electrode placement according to d’Elia (RUL).MethodsAfter the first session (Thymatron IV; energy: 20%; pulse width: 0.5; EEG: 45 s), marked hemifacial erythema and supraorbital lid swelling on the right side were evident. After each of the total seven sessions with adequate seizures in the EEG between 45 to 68 s, hemifacial erythema and supraorbital eyelid swelling were evident on the right side.ResultsBoth supraorbital eyelid edema occurred immediately after seizure onset, and hemifacial erythema resolved spontaneously and entirely within 10 minutes after the termination of the respective seizure.ConclusionsThe right side of the face appeared normal before ECT and had no injuries or abnormalities. Trauma, allergic reactions to the anesthetic, or complications of manual ventilation were excluded. In the literature, only one case report with supraorbital eyelid edema [2] and one case report with hemifacial redness of the face [3] after ECT have been described so far. We evaluate the eyelid edema and erythema that occurred in our case as isolated benign complications, most likely due to autonomic activation of facial nerves due to electrical stimulation in RUL.Disclosure of InterestNone Declared

The Eyelid Angiosarcoma: A Systematic Review of Characteristics and Clinical Course.

A systematic search for eyelid angiosarcoma was performed from inception to December 2020 in Medline, EMBASE, and the Cochrane databases. Forty two eyelid angiosarcoma cases in 32 articles were analyzed. Eyelid angiosarcomas showed an incidence peak in the eighth decade of life, and was reported more frequently in Caucasian males. Eyelid angiosarcomas were associated with a mortality rate of 26.2%, a recurrence rate of 14.3%, and a cure rate of 45.2%. Four years event-free survival (EFS) rate was 36.0%, with median EFS of 36 months. Eyelid angiosarcomas with bilateral involvement or metastasis showed higher mortality and recurrence rates than unilateral eyelid invasion cases. In the prognosis analysis according to treatment modalities, the mortality and recurrence rates were the lowest in patients who underwent surgical excision. The 4-year EFS probability in a group with surgical excision was 60.6%, but in a group without surgical excision it was 30.3%. A total of 45.2% of the cases was misdiagnosed and 21.4% of the cases could not be correctly diagnosed with the first biopsy trial. The prognosis for eyelid angiosarcomas was better than that of angiosarcomas invading the face and scalp. Surgical excision was the most important treatment modality; thus, should be considered as the first treatment of choice.

Addition of "Septal Window" to Lower Blepharoplasty for the Management of Fat of the Lower Eyelids.

The most common reason for dissatisfaction and reoperation in lower blepharoplasty patients is persistent bulging of the lateral fat pad. This compartment contributes the most to fat herniation and yet is the most commonly overlooked. The addition of a septal window, a small opening of the septum on the most prominent part of the lateral fat compartment, helps with precise removal of lateral fat and allows for additional fat excision after septal reset without disrupting the arcuate expansion. Our lower blepharoplasty approach includes 1) a subcilliary incision; 2) aggressive lateral fat excision through a septal window; 3) central and medial fat excision, transposition, and septal reset; 4) canthopexy; 5) orbicularis oculi muscle suspension; and 6) no dissection of orbicularis oculi medially and no skin resected medially to avoid lid retraction. We performed a retrospective review of all lower blepharoplasty cases by a single surgeon over 10 years. Demographics and operative outcomes were queried. There were 224 cases, 90% were women with a mean age of 58.2 years. The most common postoperative occurrences were eyelid edema, malar edema, and chemosis, all of which were self-limiting. Two patients needed additional removal of lateral fat of their lower eyelids.Two patients had lid retraction, one of which had a previous facial nerve palsy and the other did not have a canthopexy and developed transient unilateral lid retraction that resolved with conservative treatment. Resumption of full activities and exercises at 6 weeks was typical. The septal window facilitates aggressive resection of the lateral fat pad and additional fat excision after septal reset to create a smooth lid-cheek junction. In our practice, it is a critical component of a successful lower blepharoplasty.

Cerebral arteriovenous fistulas and orbital presentation. Diagnosis and treatment

AbstractPurposeTo present three cases of cerebral arteriovenous fistula with first clinical presentation from the orbit.MethodsThree women (50, 82 and 87 years old) experienced unilateral eyelid swelling with conjunctival chemosis, proptosis, diplopia, blurred vision and increased intraocular pressure. No known history of brain injury, peri‐ocular or sinus infection. They underwent blood tests for endocrine, autoimmune or infectious disease, Ear‐Nose‐Throat (ENT) assessment, orbital computed tomography (CT) and magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) and digital subtraction angiography (DSA).ResultsBlood tests and ENT assessment were negative, MRA did not show any related pathology. Orbital CT and MRI, with contrast agent, showed dilatation of the corresponding superior ophthalmic vein in all three patients. Two of them underwent DSA showing cerebral arteriovenous fistula (dural AVF) involving the cavernous sinus with retrograde blood flow to the ophthalmic vein. They underwent neurosurgical embolization of the fistula.ConclusionsCerebral arteriovenous fistulas involving the cavernous sinus may have only clinical presentation from the orbit and only imaging finding the dilatation of the corresponding ophthalmic vein in CT or MRI scans. In a case of unilateral proptosis and dilated conjunctival vessels, we should take into consideration the diagnosis of cerebral arteriovenous fistula.

Unilateral eyelid ptosis: A case report cured by Gelsemium sempervirens

Our aim is to present the importance of mobile Handheld Lung Ultrasound (HLUS) in COVID-19 patients at the bedside, which is a pre-screening tool with high diagnostic value that can provide triage of symptomatic patients at home (pre-hospital), emergency services, Intensive Care Units (ICU). In this context, the current role and importance of HLUS at the bedside in COVID-19 pneumonia has been summarized.

They Look but Do Not See—Gaze‐Evoked Eyelid Spasm

They Look but Do Not See—<scp>Gaze‐Evoked</scp> Eyelid Spasm

Contralateral eyelid elevation following unilateral upper eyelid retraction repair

ABSTRACT Purpose To report the influence of unilateral upper eyelid retraction repair on the upper eyelid position of the contralateral, non-operative side. Methods An IRB-approved retrospective chart review was performed to identify patients who underwent unilateral upper eyelid retraction repair. Patient demographics, etiology of upper eyelid retraction, previous surgeries, and periocular measurements from pre-operative and follow-up visits were reviewed. Results Thirteen patients who underwent unilateral upper eyelid retraction repair due to thyroid eye disease or iatrogenic retraction secondary to ptosis repair demonstrated an elevation in contralateral eyelid height post-operatively. The mean pre-operative MRD-1 was 6.6 mm in the operative eye and 2.6 mm in the contralateral eye. All patients demonstrated a decreased MRD-1 in the operative eye (mean change: −2.6 mm [−38.4%]; standard deviation [SD]: 1.2 mm) and an increased MRD-1 in the contralateral eye (mean change: +1.3 mm [+62.4%]; SD: 0.6 mm) following unilateral upper eyelid retraction repair. The mean post-operative MRD-1 measurements were 4.0 mm ± 0.5 mm and 3.9 mm ± 0.6 mm in the operative and contralateral eyes, respectively. Conclusions Unilateral upper eyelid retraction repair may induce an elevation of the contralateral upper eyelid position in some patients. The findings in this report may support unilateral intervention in patients with upper lid retraction, especially in the setting of contralateral blepharoptosis.