Severe Upper and Lower Tarsal Ectropion with Immunoglobulin G4-related Ophthalmic Disease

ABSTRACT

Purpose@#To present the first case of severe upper and lower tarsal ectropion associated with immunoglobulin G4 (IgG4)-relatedophthalmic disease.Case summary: A 37-year-old male presented with relapsed eyelid swelling and periocular inflammation in the left eye for7 years. He had severe upper and lower tarsal ectropion and a thickened upper eyelid with prolapsed conjunctival fornix. Orbitalcomputed tomography showed a poorly defined anterior orbital mass involving the lacrimal gland and upper and lower eyelids onthe left eye. The severe upper and lower eyelid ectropion was corrected by a modified spindle procedure and lateral tarsal strip.Hard, ill-defined fibrotic tissue and a mass around the lateral upper tarsal plate were discovered that required excision of themass and a biopsy. Hematologic and histopathologic findings of the orbital mass indicated IgG4-related ophthalmic disease withsevere upper and lower ectropion caused by the disease. @*Conclusions@#In cases of severe upper and lower eyelid ectropion caused by chronic inflammation, as seen in this case, not onlyeyelid tightening with excision of the causative mass but also a modified spindle procedure is required to prevent rotation of theeyelid.