A Case of Idiopathic Upper Eyelid Swelling Treated by Upper Eyelid Blepharoplasty

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.

The Relationship between the High-Frequency Component of Accommodative Microfluctuation, Accommodative Lag and Accommodative Amplitude in Presbyopic Eyes

PURPOSE: To determine the relationship between the high-frequency component of accommodative microfluctuation (HFC) and accommodative lag in presbyopic eyes and how they affect the subjective accommodation power with other ophthalmic factors, such as pupil diameter and corneal multifocality. METHODS: Forty subjects (80 eyes) were included in this study, and the non-corrected distance and near visual acuity was measured and then converted to log MAR vision. The addition power for 33 cm near visual work was also measured and the accommodative power was measured by the push-up method. The HFC, accommodative lag and pupil size according to accommodative stimuli (-1.0 to -3.0 D) was measured by Speedy-i Autorefractor (Right Mfg Co., Tokyo). The corneal multifocality and corneal astigmatism was measured by corneal topography (TMS-4; Tomey, Erlangen, Germany). RESULTS: The mean age was 60.0 +/- 4.66 years (51-68) and there were 23 male and 17 female subjects (1.35:1). The HFC and pupil size showed no significant change according to accommodation demand, however, the accommodative lag showed a statistically significant increase (p < 0.001 by one-way ANOVA). Accommodative lag (-2.0 D) showed a statistically significant negative correlation with the subjective accommodative power, and the pupil size (0 D) showed a positive correlation with the subjective accommodative power. CONCLUSIONS: In presbyopia patients, the objective accommodative lag and initial pupil size showed a statistically significant relationship with subjective accommodative power. On the other hand, HFC, pupil size and corneal multifocality, alone may not be indicators to predict accommodative power, but these are important components to explain the dynamic aspect of accommodation.

Thrombocytopenia after Intravitreal Bevacizumab Injection for Macular Edema in Branch Retinal Vein Occlusion

PURPOSE: To report a rare case of thrombocytopenia after intravitreal bevacizumab injection (IVBI) in a patient with macular edema secondary to branch retinal vein occlusion (BRVO). CASE SUMMARY: A 52-year-old female presented to our clinic with complaints of visual disturbance in her right eye for 2 months. She was receiving hemodialysis therapy 3 times a week for 4 years due to chronic renal failure. Unilateral macular edema secondary to BRVO was observed on fundus examination and was confirmed with optical coherence tomography (OCT). The first IVBI was performed, and an additional injection was given 4 weeks later. Four weeks after the second injection, thrombocytopenia was present. The patient was followed up in our clinic without IVBI for 8 weeks and the platelet count recovered. Thrombocytopenia was reconfirmed after 2 additional monthly injections. After she revisited our clinic without IVBI for 8 weeks, the platelet count recovered without any treatment. CONCLUSIONS: When a patient presents with thrombocytopenia after IVBI with macular edema in BRVO, thrombocytopenia due to IVBI should be considered as a possible diagnosis.