A Case of Orbital MALT Lymphoma in a Patient with Rheumatoid Arthritis

PURPOSE: To report a case of orbital mucosa-associated lymphoid tissue (MALT) lymphoma that occurred in a patient with rheumatoid arthritis (RA). CASE SUMMARY: A 70-year-old male with alleged RA presented with a 3-month history of spontaneous and painless upper and lower eyelid swelling in the right eye. On initial examination, palpable nodules were observed at the right upper and lower eyelids and orbital computed tomography (CT) revealed a contrast-enhancing nodule just inferior to the lacrimal gland, thus an incisional biopsy was performed. The pathological report showed malignant orbital lymphoma (low grade extranodal marginal zone B cell lymphoma of MALT). Since distant metastases were not detected on whole-body CT and positron emission tomography, the patient was advised to keep previous medication and regular follow-up examinations. CONCLUSIONS: The possibility of MALT lymphoma should be considered as a differential diagnosis in patients with eyelid swelling and autoimmune diseases such as RA.

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 significance of upper eyelid swelling in early diagnosis and treatment of infectious mononucleosis / 中国基层医药

Objective To understand the significance of upper eyelid swelling in early diagnosis and treat-ment of infectious mononucleosis(IM).Methods We early diagnosed these patients IMwith upper eyelid swelling, fever and lymph node enlargement under five days course of disease,and compared the coincidence rate with last diag-nosis,investigated the rate of upper eyelid swelling in non -early diagnosis cases with the course of disease above one week,and evaluated the effect of ganciclovir in treating IMin two groups.Results The coincidence rate was 97.14%in early and last diagnosis groups,and the rate of upper eyelid swelling was 60.2% in non -early diagnosis group. There were significant differences in disappear of upper eyelid swelling,fever and lymph node enlargement in the two groups.Conclusion Upper eyelid swelling has important significance in early diagnosis and treatment of IM.

A Case of Epstein-Barr Virus-Related Dacryoadenitis

PURPOSE: To report a case of Epstein-Barr virus-related dacryoadenitis. CASE SUMMARY: A 19-year-old female presented with pain, swelling and redness of both upper eyelids. She experienced rhinorrhea, cough and fever for the previous two weeks. Physical exam showed bilateral cervical lymph node enlargement, and orbital computed tomography (CT) revealed diffuse enlargement and inflammation of both lacrimal glands. Serological testing revealed elevated titers for Epstein-Barr virus nuclear antigen immunoglobulin G (IgG) and Epstein-Barr viral capsid antigens IgG and immunoglobulin M (IgM). Based on these results, clinical diagnosis of Epstein-Barr virus-related acute dacryoadenitis was made. The inflammation subsided after conservative management. Relapse was not observed during the three-month follow-up period. CONCLUSIONS: Based on acute bilateral lacrimal gland enlargement, systemic symptoms such as fever, rhinorrhea, cough, lymphadenopathy and serologically-positive results for Epstein-Barr virus, Epstein-Barr virus-related acute dacryoadenitis can be clinically diagnosed and treated with conservative therapy.

Adult Orbital Xanthogranulomatous Disease in a 42-Year-Old Woman

PURPOSE: To report a case of adult orbital xanthogranulomatous disease presented as bilateral swelling and yellowish eyelids in a 42-year-old woman who was misdiagnosed with xanthelasma at a dermatologic clinic. CASE SUMMARY: A 42-year-old woman presented yellowish and swollen eyelids in both eyes of 2.5 year duration. She had no past history of systemic diseases or other ophthalmologic problems. MRI showed heterogeneous eyelid masses and hypertrophic changes of the lacrimal glands in both eyes. There were no abnormalities on chest X-ray exams. The blood cholesterol and low density lipoprotein levels were increased. Incisional biopsy showed many foamy histiocytes, lymphocytes with germinal centers, several touton giant cells, and negative S100/CD 1 staining; all being features consistent with adult onset xanthogranulomatous disease. CONCLUSIONS: In cases with bilateral swelling and yellowish colored eyelids, adult orbital xanthogranulomatous disease should be evaluated through biopsy and other systemic examinations.

Relapsing Polychondritis Presenting with Repeated Inflammation of Bilateral Eyelid and Conjunctiva

PURPOSE: To report a rare case of a 62-year-old man who presented with bilateral eyelid swelling, chemosis, and hyperemia of the conjunctiva, which wax and waned, being the initial manifestation of relapsing polychondritis. CASE SUMMARY: A 62-year-old man presented with pain and erythematous swelling of the right eyelid for 2 days. There were no other symptoms except chemosis and hyperemia of the conjunctiva. After 1 week, the same symptoms occurred in the left eye, while the lesion of the right eye underwent improvement and aggravation repeatedly. Blood culture tests, Orbital CT, and MRI were performed, but could not confirm a diagnosis. During the follow-up period, erythematous swelling of the left auricle and laryngopharyngitis appeared and erythematous plaques were scattered on the extremities. Punch biopsies were performed; histopathologic examinations concluded to the diagnosis of chondritis. The diagnosis of relapsing polychondritis was confirmed through histologically diagnosed chondritis and repeated ocular symptoms with systemic features. CONCLUSIONS: When patients repeatedly present bilateral eyelid swelling with hyperemia and chemosis of the conjunctiva, relapsing polychondritis should be considered in the differential diagnosis.

Idiopathic Orbital Inflammation Presenting as Unilateral Dacryoadenitis in a Child

PURPOSE: To report a case of idiopathic orbital inflammation presenting as unilateral acute dacryoadenitis in a child. CASE SUMMARY: A nine-year-old boy presented with painful swelling and redness in the right upper eyelid and temporal conjunctiva without systemic symptoms for five days. Acute orbital cellulitis was suspected but did not respond to systemic antibiotics. An orbital computed tomogram and magnetic resonance imaging revealed a diffusely enlarged and inflamed right lacrimal gland. The patient showed dramatic response to systemic corticosteroids, and acute dacryoadenitis due to idiopathic orbital inflammation was diagnosed. Treatment with oral corticosteroids for two months resolved the inflammation. No relapse was observed during four months of follow-up. CONCLUSIONS: Although rare, acute dacryoadenitis as a localized nonspecific orbital inflammation should be considered in the differential diagnosis of acute orbital cellulitis in pediatric patients.

Kimura's Disease Involving the Ipsilateral Face and Extraocular Muscles

Kimura's disease (KD) is a rare, chronic inflammatory disorder, which is characterized by tumor-like masses mainly located in the head and neck region. Extraocular muscle involvement in KD is uncommon. We report a case of KD that involved both the extraocular muscles and buccal area. A 13-year-old male presented to our clinic with a two-year history of exophthalmos of the left eye and facial swelling. Facial CT and MRI showed a 1.5 x 1.5 cm2 soft tissue mass located at the left masticator and buccal area, exophthalmos of the left eye, and diffuse thickening of the left extraocular muscles. We performed a lateral rectus muscle incisional biopsy of the left eye. Oral methylprednisolone therapy was initiated and tapered following the incisional biopsy.

Kimura's Disease Involving The Eyelid and Orbit

PURPOSE: Kimura's disease is a benign slow-growing subcutaneous tumor, which is manifested clinically by one or more inflammatory nodules invading mainly the head and neck. Orbital, eyelid and lacrimal involvement by Kimura disease is rare. We report two cases of Kimura's disease involving the orbit and eyelid , which has not been reported in korea. METHODS: A 16-year-old male patient presented with the chief complaint of upper eyelid swelling and ptosis that was first noticed 15 years ago. Another 16-year-old male patient visited our clinic with multiple nodules involving the head, neck, left upper arm, and the both upper eyelids . Ocular examination of case.1 revealed upper eyelid swelling and redness, painless nodule, and ptosis. In case 1. patient, Orbital MRI scan showed thickening of the superior, inferior, medial rectus muscle, levator palpebrae muscle, and a well-demarcated homogenous mass in the superonasal portion of the left orbit. RESULTS: Histopathologically, the lesions were characterized by lymphoid follicles, infiltration of many eosinophils, lymphocytes, abnormal capillary proliferation and fibrosis. Laboratory findings definitely revealed peripheral blood eosinophilia in both patients. CONCLUSIONS: Kimura's disease should be suspected and considered in the differential diagnosis for the patients with the eyelid swelling and mass.