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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 58  |  Issue : 3  |  Page : 197-199

Sarcoidosis of eyelid


Department of Orbit, Oculoplasty and Ocular Oncology, Narayana Nethralaya, Bengaluru, Karnataka, India

Date of Submission12-May-2020
Date of Acceptance20-Jul-2020
Date of Web Publication14-Sep-2020

Correspondence Address:
Dr. Rwituja Thomas
Oculoplasty and Oncology Services, Narayana Nethralaya, 121/C, Chord Road, Rajajinagar, Bengaluru - 560 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_52_20

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  Abstract 


A 53-year-old woman presented with plaque-like lesions on the upper and lower lids of both eyes including the tear trough. To confirm the diagnosis, incisional biopsy of one of the lesions was done. Histopathology confirmed the diagnosis to be sarcoidosis, with typical noncaseating granulomatous changes. Systemic evaluation revealed hilar lymphadenopathy. She was treated with oral steroids, and the lesion had completely resolved by 3 months. Sarcoidosis of the eyelids is a rare condition and may present as the first manifestation. An early biopsy can help confirm diagnosis and avoid systemic morbidity.

Keywords: Eyelid plaque, eyelid sarcoidosis, sarcoidosis


How to cite this article:
Thomas R, Hari P, Gupta R. Sarcoidosis of eyelid. TNOA J Ophthalmic Sci Res 2020;58:197-9

How to cite this URL:
Thomas R, Hari P, Gupta R. Sarcoidosis of eyelid. TNOA J Ophthalmic Sci Res [serial online] 2020 [cited 2020 Oct 25];58:197-9. Available from: https://www.tnoajosr.com/text.asp?2020/58/3/197/294996




  Introduction Top


Sarcoidosis is a granulomatous infiltrative multisystem disease with dermatologic as well as ophthalmic manifestations. It usually occurs in the third to fourth decades and is more common among women.[1]

Pulmonary involvement is the most common manifestation. Ocular involvement occurs in 25%–60% of patients with systemic sarcoidosis.[2],[3] It can involve any ocular structure, but anterior uveitis and dacryoadenitis are the most common manifestations reported.[4] Eyelid manifestations of sarcoidosis are rare, and very few reports are available in literature.


  Case Report Top


A 53-year-old woman presented with swelling on the upper and lower lids of both eyes for 1 week. The patient did not have any systemic complaints. On examination, she had a raised plaque-like well-demarcated lesion on the lower and upper lids of both eyes measuring about 10 mm × 5 mm size [Figure 1]. The locations of the lesions were typical of xanthelasma. The skin over the lesion was hyperpigmented. The lesion was firm in consistency and nontender. On palpation, the lesions appeared to be subcutaneous in location but free from deeper tissues. Ocular examination was unremarkable.
Figure 1: Clinical photograph showing eyelid lesions

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Biopsy obtained from the lesion showed noncaseating granulomatous reaction with epithelioid cells and Langhans-type giant cells, which was suggestive of sarcoidosis [Figure 2]a. Ziehl–Neelsen staining was negative [Figure 2]b. On further evaluation, computed tomography scan showed hilar lymphadenopathy [Figure 3]. Serum angiotensin-converting enzyme (ACE) level was 43 units/l. Mantoux test was negative. She was started on oral prednisolone1 mg/kg, tapered over 12 weeks, and reviewed regularly. The eyelid lesions had completely resolved at the end of 4 months [Figure 4].
Figure 2: (a) Histopathology: Photomicrograph showing noncaseating granulomas with epithelioid cells and Langhans giant cells and lymphocyte infiltrates. (b) Histopathology: Ziehl–Neelsen staining showing no acid-fast bacilli

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Figure 3: Computed tomography scan showing hilar lymphadenopathy

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Figure 4: Completely resolved lesions with treatment

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  Discussion Top


The most common orbital manifestation of sarcoidosis is involvement of the lacrimal gland.[2] Eyelid involvement is a rare manifestation of sarcoidosis. Earlier reports suggest an incidence of about 12%.[3] The common sarcoidosis lesions in the eyelid skin include millet-seed nodules, plaque, nodules, or ulcerated appearance.[5] A rare presentation was described in 1990 with nodules of both lids near the medial canthi.[5] The patient also had multiple such lesions on the arm and face. Biopsy of the eyelid lesion confirmed the diagnosis. A 34-year-old female presenting with flesh-colored papular lesions near the medial canthal area in both eyes has also been reported.[6]

Recurrent painless swelling of eyelids and the periorbital region is the other common presentation.[7],[8] A 70-year-old female with a similar presentation on evaluation had hilar lymphadenopathy and an old tubercular scar in the chest X-ray.[6] Tubercular skin test and immunoglobulin assay were negative for tuberculosis; serum ACE and erythrocyte sedimentation rate were elevated. Excision biopsy of the lesion confirmed the diagnosis. The patient was treated with oral steroids, and the lesions had resolved completely in 12 weeks.

A lateral canthal nontender erythematous mass in a patient with raised ACE and hilar lymphadenopathy and nonspecific scarring of the lungs was reported. Despite treatment with intralesional steroids, excision biopsy done 9 months later was consistent with sarcoidosis-like features.[9]

In the present case, the patient was systemically asymptomatic with no past history of sarcoidosis. She presented with swelling on both eyes, located subcutaneously. These lesions were located in the area where typically a xanthelasma is seen. A biopsy was considered as the lesions did not conform to any characteristic appearance, with firm consistency and hyperpigmentation of the overlying skin.

Management strategies for eyelid sarcoidosis include intralesional steroid, surgical debulking of large lesions, and medical therapy with oral steroids and immunosuppressants. The lesions respond well to oral steroids generally, as seen in the present case where complete resolution of the lesion was seen over a period of 4 months.[10]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Birnbaum AD, Rifkin LM. Sarcoidosis: Sex-dependent variations in presentation and management. J Ophthalmol 2014;2014:236905.  Back to cited text no. 1
    
2.
Jabs DA, Johns CJ. Ocular involvement in chronic sarcoidosis. Am J Ophthalmol 1986;102:297-301.  Back to cited text no. 2
    
3.
Prabhakaran VC, Saeed P, Esmaeli B, Sullivan TJ, McNab A, Davis G, et al. Orbital and adnexal sarcoidosis. Arch Ophthalmol 2007;125:1657-62.  Back to cited text no. 3
    
4.
Obenauf D, Shaw HE, Sydnor CF, Klintworth GK. Sarcoidosis and its ophthalmic manifestations. Am J Ophthalmol 1978;86:648-55.  Back to cited text no. 4
    
5.
Brownstein S, Liszauer AD, Carey WD, Nicolle DA. Sarcoidosis of the eyelid skin. Can J Ophthalmol 1990;25:256-9.  Back to cited text no. 5
    
6.
Hall JG, Cohen KL. Sarcoidosis of the eye lid skin. Am J Ophthalmol 1995;119:100-101.  Back to cited text no. 6
    
7.
Lee JK, Moon NJ. Orbital sarcoidosis presenting as diffuse swelling of the lower eyelid. Korean J Ophthalmol 2013;27:52-4.  Back to cited text no. 7
    
8.
Pessoa de Souza Filho J, Martins MC, Sant'Anna AE, Coutinho AB, Burnier MN Jr., Rigueiro MP. Eyelid swelling as the only manifestation of ocular sarcoidosis. Ocul Immunol Inflamm 2005;13:399-402.  Back to cited text no. 8
    
9.
Cacciatori M, McLaren KM, Kearns PP. Sarcoidosis presenting as a cutaneous eyelid mass. Br J Ophthalmol 1997;81:329-30.  Back to cited text no. 9
    
10.
Pasadhika S, Rosenbaum JT. Ocular Sarcoidosis. Clin Chest Med 2015;36:669-83.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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