Journal List > J Korean Ophthalmol Soc > v.56(1) > 1010047

Choi, Ju, and Yum: A Case of Idiopathic Upper Eyelid Swelling Treated by Upper Eyelid Blepharoplasty

Abstract

Purpose

To report a case of idiopathic upper eyelid swelling with minimal response to steroid treatment treated by upper eyelid blepharoplasty.

Case summary

A 69-year-old man with diabetes mellitus and smoking history, presented upper eyelid swelling in both eyes starting 5 years ago. The patient had been receiving systemic steroid treatment for idiopathic upper eyelid swelling, though each attempt to taper steroid treatment led to recurrence of eyelid swelling. In the initial examination, both upper eyelids showed swelling. For differential diagnosis, a work-up including laboratory test and computerized tomography (CT) scan of the orbit were initiated. There were no abnormalities on laboratory tests including the thyroid function test. A CT scan of the orbit was unremarkable. For managing symptoms and inflammation, smoking was stopped and steroid treatment was administered. The patient still, however, complained of discomfort and swelling. To relieve symptoms and debulk inflammatory tissue, bilateral upper eyelid blepharoplasty was performed. The patient experienced reduced discomfort after the surgery. The biopsy showed no abnormalities, except for mild inflammation.

Conclusions

We present a case of idiopathic upper eyelid swelling despite steroid treatment. In this case, upper eyelid blepharoplasty was used with excellent functional and cosmetic outcomes. Thus, suspension of steroid treatment in cases of patients with recurrent eyelid swelling, in spite of steroid treatment, should be considered.

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Figure 1.
Clinical photographs of the patient's eyelid and axial view of orbit CT before starting treatment. (A, B) These pictures show bilateral eyelid swelling, especially in left upper eyelid. (C) CT showed only swelling of connective tissue of upper eyelid and there was no mass like lesion.
jkos-56-119f1.tif
Figure 2.
(A) Microscopic examination shows some interstitial hemorrhage and inflammatory cells in the eyelid tissue (Hematoxylin- eosin, ×400). (B) Hematoxylin and eosin stain shows clusters of fibroadiopse tissues in the preaponeurotic fat (×400).
jkos-56-119f2.tif
Figure 3.
Clinical photographs of the patient's eyelids. (A) After blepharoplasty at 3 months. (B) After blepharoplasty at 8 months. These pictures show decreased eyelid swelling.
jkos-56-119f3.tif
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