A Rare Manifestation Of Discoid Lupus Erythematosus Solely In The Lower Eyelid Of A Young Man
Published 2024 - 42nd Congress of the ESCRS
Reference: PO1117 | Type: Free paper | DOI: 10.82333/y7we-rw15
Authors: Nefeli Eleni Kounatidou* 1 , Konstantina Bachtalia 2 , Konstantina Frangia-Tsivou 3 , Andreas Patelis 4 , Sotiria Palioura 5
1Universitätsklinikum Hamburg Eppendorf,Hamburg,Germany, 2University of West Attica,Athens,Greece, 3HistoBio Diagnosis Pathology Lab,Athens,Greece, 4Ophthalmology Clinic,Athens,Greece, 5Bascom Palmer Eye Institute,Miami,United States
Purpose
We present a rare case of a young patient with enduring, unilateral lower eyelid edema and erythema that had been managed as blepharitis for several years.
Setting
Discoid lupus erythematosus (DLE)-associated edema and erythema on the lower eyelid as the only manifestation of the disease is a rare clinical entity. Persistent discoid lupus-related lower eyelid manifestations are challenging to diagnose, can be mistaken for blepharitis or malignancies, and often require histopathological evaluation. If left untreated, the condition can progress, among others, to conjunctival scarring or symblepharon formation.
Methods
A 24-year-old otherwise healthy Caucasian male presented with a three-year history of persistent unilateral lower eyelid edema and erythema. The patient had been previously managed for chronic blepharitis. However, persistent clinical signs prompted additional diagnostic considerations. External examination revealed a central erythematous lesion on the left lower eyelid with hyperpigmentation, adherent scaling, and scarring. Slit-lamp examination showed prominent thickening and inflammation across the left lower eyelid margin, which was associated with derangement of the mucocutaneous junction, hypertrophy of the meibomian glands, and focal conjunctival injection. No corneal involvement was identified.
Results
A biopsy of the lower eyelid skin was performed, which revealed microscopic findings consistent with DLE. The patient was referred to Rheumatology for further workup and management. Serology testing for the presence of autoimmune dysregulation was performed and was negative for the lupus extractable nuclear antigen (ENA) panel (i.e., Ro, La, Sm, RNP, Scl-70, and Jo1). The patient was started on daily hydroxychloroquinolone with resolution of his signs and symptoms at his 18-month follow-up.
Conclusions
Persistent unilateral lower eyelid sole manifestations due to DLE are scarce and can be challenging in terms of diagnosis and proper management. Progression of this condition can lead to conjunctival scarring or symblepharon formation. Prompt identification and differentiation from other eye and life-threatening pathologies via clinical and histopathological evaluation are of the utmost importance.