Purpose: To report a case of upper eyelid keratoacanthoma with a cutaneous horn.Case summary: A 59-year-old female presented to our clinic with a rapidly growing, painless mass in the center of the right upper eyelid. A 2 × 2 × 5 mm dark brown conical hyperkeratotic mass and a 7 × 4 mm nodular, nontender mass were palpable on the right upper eyelid. The lesion was isolated from the surrounding tissues and excised completely. Histopathologically, the excised masses showed parakeratosis along with hyperkeratosis of the conical mass and the keratin plug, keratin pearls, and epithelial proliferation in the nodular mass. These findings led to a diagnosis of eyelid keratoacanthoma with a cutaneous horn. Conclusions Eyelid keratoacanthomas may be accompanied by cutaneous horns and confused with squamous cell carcinomas. The treatment is complete excision, which should be followed by histopathological analysis

PURPOSE: To report a rare case of upper eyelid schwannoma presenting as a chalazion. CASE SUMMARY: A 54-year-old male presented to our clinic with a slowly growing, painless recurred mass located in the middle area of the right upper eyelid margin. Surgical incision had been performed on a similar mass two year previous, although no histological analysis had been performed. On examination, a 4 × 3-mm-sized, firm, nonpigmented mass was palpable in the right upper eyelid, and no signs of neurofibromatosis were present elsewhere. The lesion was initially thought to be an eyelid mass, so we performed an excisional biopsy under local anesthesia. The lesion was easily isolated from the surrounding tissue and was excised completely. Histopathologically, the excised mass showed a compact arrangement of spindle cells forming palisades with Verocay bodies (Antoni A patterns). Immunohistochemistry revealed diffuse and strong S-100 protein positivity. These findings resulted in the diagnosis of eyelid schwannoma. CONCLUSIONS: Because of its rarity and solitary feature, eyelid schwannoma can be confused with chalazion. Thus, ophthalmologists should consider schwannoma in the differential diagnosis of a slowly growing, painless recurred mass or a lesion with malignant transformation after incomplete excision.
Anesthesia, Local ; Biopsy ; Chalazion ; Diagnosis ; Diagnosis, Differential ; Eyelids* ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Neurilemmoma* ; Neurofibromatoses ; S100 Proteins

PURPOSE: Lymphoma originated from MALT is common in stomach but infrequently found in bronchus, salivary gland, thyroid gland and orbit. We report a case of multifocal MALToma in bilateral main lacriamal gland, hard palate without systemic metastasis. METHODS: A 45-year-old male without known systemic disease visited with movable mass in left upper eyelid for 5 months. RESULTS: We found the mass which was hot uptaked by whole body SPECT in left main lacrimal gland and hard palate. By excisional biopsy, the mass was diagnosed as MALToma. After 1 year it recurred in contralateral main lacrimal gland. It was diagnosed as the same MALToma by excisional biopsy. Relapse and other metastasis have not been observed yet up to now(November, 2002) , since we treated radiation therapy.
Biopsy ; Bronchi ; Eyelids ; Humans ; Lacrimal Apparatus* ; Lymphoma ; Male ; Middle Aged ; Neoplasm Metastasis ; Orbit ; Palate, Hard* ; Recurrence ; Salivary Glands ; Stomach ; Thyroid Gland ; Tomography, Emission-Computed, Single-Photon

PURPOSE: Through 13 cases of lacrimal ductal cysts which were diagnosed by clinical or histopathological findings, we investigated the clinical characteristic and the effect of cyst excision on lacrimal secretion. METHODS: As a primary treatment, cyst excisions(6 cases), marsupialzations(4 cases), and needle aspirations(3 cases) were performed and their results were compared. Pre-and postoperative lacrimal secretion tests(Schirmer I & BST) were performed on 10 cases which underwent cyst excision either primarily or secondarily(due to recurrences). A biochemical analysis of cyst fluid and serum IgA level was also done on 7 cases. RESULT: There were no recurrences on 6 surgically excised cases, but 1 out of 4 cases with marsupia-lizations and all 3 cases with needle aspirations recurred and underwent cyst excisions secondarily. Two out of 10 surgically excised cases showed reduced value of postoperative lacrimal secretion tests. Cyst fluid IgA levels were higher than that of serum in all 7 cases. CONCLUSION: The higher cyst IgA level may signify the presence of an active secretory precess within cyst walls. A complete cyst excision seems to be the best treatment choice for the prevention of recurren-ces and marsupialization is also considered as an alternative treatment modality. The cyst excision itself does not seem to affect lacrimal secretion.
Aspirations (Psychology) ; Cyst Fluid ; Immunoglobulin A ; Needles ; Recurrence

Sebaceous carcinoma of the eyelid is a rare tumor that usually arises from tarsal sebaceous gland. Because the clinical manifestations can masquerade as unilateral recurrent chalasion or chronic blepharoconjunctivitis, its diagnosis may be delayed. Therefore, early biopsy for diagnosis is needed for the persistently recurring unilateral blepharoconjunctivitis. The masquerade syndrome was first described in 1967 by Theodore and Irvine as chronic blepharoconjunctivitis due to an underlying conjunctival carcinoma. While the originally described neoplasms were squamous cell carcinomas, many of the tumors producing this clinical picture are believed to be sebaceous in origin. We experienced a case of pathologically confirmed sebaceous carcinoma of the eyelid which originally masqueraded as chronic blepharoconjunctivitis and was treated with topical antibiotics and steroids for 1 year and 8 months, finally being treated by partial orbital exenteration.
Anti-Bacterial Agents ; Biopsy ; Carcinoma, Squamous Cell ; Conjunctivitis* ; Diagnosis ; Eyelids ; Orbit ; Sebaceous Glands ; Steroids

PURPOSE: To report a case of Merkel cell carcinoma on the left upper eyelid without metastasis and its immunohistochemical features. The carcinoma was successfully treated with excisional surgery and prophylactic radiation therapy. CASE SUMMARY: A 76-year-old woman presented to the hospital complaining of a 0.6 x 0.9-cm-sized painless and purplish-red colored mass that had grown rapidly on her left upper eyelid margin over the previous two months. An excisional biopsy was performed. On immunohistochemical examination of the lesion, the tumor cells expressed immunoreactivity for synaptophysin and were negative for LAC and cytokeratin, confirming the diagnosis of Merkel cell carcinoma. Additional surgery was performed because the surgical margins were positive. No other primary or metastatic lesions were found. The patient was treated with local prophylactic irradiation and remained disease-free at her 10-month follow-up visit.
Aged ; Biopsy ; Carcinoma, Merkel Cell ; Eyelids ; Female ; Follow-Up Studies ; Humans ; Keratins ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Synaptophysin

Tuberculosis of the lid is a rare disease that usually extends directly from surrounding tissues such as paranasal sinuses and lacrimal glands, or occurs possibly as a result of hematogenous spread. Primary tuberculous infection of lid also rarely occurs. The earliest lesion is a brownish red, soft papule that develops into an indurated nodule or plaque that may ulcerate. There is usually prominent lymphadenopathy. The diagnosis is established through tuberculin skin testing, stains for acid-fast organisms, and cultures. If diagnosis is delayed, complications including extensive orbital tissue damages, cold abscess, cutaneous fistula, and cicatricial ectropion may ensue. Lid tuberculosis should be differentiated from other granulomatous lesions of eyelid and also from other more commonly occuring orbital tumors. The combination therapy of Isoniazid, Rifampin, and Pyrazinamide is recommended for lid tuberculosis. We experienced a patient presenting with painless upper eyelid nodule that occurred about 3 weeks following upper lid blapharoplasty and treated her with anti-tuberculous medications after histological diagnosis of lid tuberculosis has been made. So, we report this rare case of lid tuberculosis with literature.
Abscess ; Coloring Agents ; Cutaneous Fistula ; Diagnosis ; Ectropion ; Eyelids ; Humans ; Isoniazid ; Lacrimal Apparatus ; Lymphatic Diseases ; Orbit ; Paranasal Sinuses ; Pyrazinamide ; Rare Diseases ; Rifampin ; Skin Tests ; Tuberculin ; Tuberculosis* ; Ulcer

PURPOSE: To evaluate the long-term effectiveness of different surgical procedures according to horizontal eyelid laxity in correcting involutional entropion. METHODS: This retrospective study reviewed 104 eyes of 79 patients with involutional lower eyelid entropion who underwent surgical repair. The 62 eyes with horizontal eyelid laxity were classified as group I. In 17 eyes of group I, we performed the lateral tarsal strip procedure alone (group Ia), while in 45 eyes of group I, we performed the lateral tarsal procedure and Quickert suture (group Ib). The 42 eyes without horizontal eyelid laxity were classified as group II. In 13 eyes of group II, we performed a lower eyelid retractor reinsertion procedure only (group IIa), and in 29 eyes of group II, we performed combined lower eyelid retractor reinsertion and orbicularis resection (group IIb). RESULTS: The recurrence rate in these four surgical subsets (group Ia , group Ib, group IIa, group IIb) was 11.7%, 0%, 15.4%, and 6.9%, respectively, with an average follow-up of 11 months. Six recurrent eyelids and two overcorrected eyelids successfully underwent procedures to correct recurrent entropion and ectropion, respectively. CONCLUSIONS: The lateral tarsal strip procedure is an effective approach for achieving long-lasting correction of involutional entropion with horizontal eyelid laxity, whereas the lower eyelid retractor reinsertion procedure is an effective approach for achieving long-lasting correction for involutional entropion without horizontal eyelid laxity. Use of the Quickert suture reduced the need to repeat the lateral tarsal strip procedure and additional orbicularis resection decreased the need to repeat the lower eyelid retractor reinsertion procedure.
Ectropion ; Entropion ; Eye ; Eyelids ; Follow-Up Studies ; Humans ; Recurrence ; Retrospective Studies ; Sutures

PURPOSE: To evaluate the causes of failed dacryocystorhinostomy (DCR) and the effects of transcanalicular diode laser-assisted endonasal revision surgery according to the number of silicone tubes. METHODS: Sixty-seven patients (70 eyes) who underwent revision surgery using transcanalicular diode laser for failed primary endonasal DCR at Sungmo Eye Hospital between March 2007 and December 2012 were studied retrospectively. The causes of failed DCR and the time of recurrence were evaluated. The revision surgeries were endoscopic removal of granuloma and membrane and synechiolysis with intubation of 1 or 2 silicone tubes. We compared the results of revision surgery with 1 silicone tube and 2 silicone tube intubations. RESULTS: Recurrence occurred after a mean duration of 4.6 months following the first DCR. The causes of surgical failure were granuloma (35 eyes), membranous obstruction (23 eyes), synechia (7 eyes), and functional obstruction (5 eyes). We performed revision surgery with 1 silicone tube intubation in 45 eyes (group A) and 2 silicone tube intubations in 25 eyes (group B). The final success rates in groups A and B were 75.6% (34/45) and 84% (21/25), respectively (chi-square test, p = 0.828). CONCLUSIONS: Transcanalicular diode laser-assisted endonasal revision surgery with 2 silicone tubes is not recommended.
Dacryocystorhinostomy ; Granuloma ; Humans ; Intubation ; Lasers, Semiconductor ; Membranes ; Recurrence ; Retrospective Studies ; Silicones*

PURPOSE: We report 2 cases treated with bilobed flap surgery for medial canthal reconstruction. METHODS: Two patients with black and painless lid mass, 1 x 1 cm size, developed at medial canthal area were excised, and medial canthal reconstruction was performed. Biopsy was done before the surgery, showing basal cell carcinoma. We designed and rotated bilobed flap to reconstruct medial canthal defect caused by the radical excision, and sutured it at the incision margin of the skin. RESULTS: Pathologic examination was done after the surgery, confirming basal cell carcinoma. No marginal cancer cell were detected. Cancer relapse did not occur during 12 months of follow-up. We obtained satisfactory results in all patients, not only clinically but also cosmetically. CONCLUSIONS: It is considered that the bilobed flap procedure is effective for reconstruction of medial canthal defect developed after eyelid tumor excision and offer a good prognosis.
Biopsy ; Carcinoma, Basal Cell ; Eyelids ; Follow-Up Studies ; Humans ; Prognosis ; Recurrence ; Skin