ASOPRSFall Scientific SymposiumSyllabus
190
T35
UniquePresentationof Periorbital Dermatomyositis
SwapnaVemuri
1
, KennethFeldman
2
.
1
Department of Ophthalmology, GavinHerbert Eye Institute, University of California - Irvine, Irvine,
CA, UnitedStates,
2
Department of Ophthalmology, Kaiser PermanenteSouthBay, Harbor City, CA, UnitedStates
Introduction:
We describe the presentation and subsequent management of a patient with dermatomyositiswho presented
with diffuse, bilateral, firm upper eyelid nodules resulting in ptosis.
Methods:
Case report.
Results:
A61-year-oldAfricanAmericanwomanwith dermatomyositis presentedwith a several year history of progressively
increasing bilateral upper eyelid heaviness and discomfort aswell as ptosis. On examination, she had diffuse, firm subcutaneous
nodules of both upper eyelidsmeasuring 2cm x 1.5cm on the right and 3cm x 1.8cm on the left (Figure 1A). She had similar firm,
pre-auricular and elbow nodules (Figure 1B). Computed tomography (CT) showed dense lobulated calcified lesions of bilateral
superior orbits (Figure 1C). Bilateral anterior orbitotomywas performed to debulk themasses in order to improve the visually
significant ptosis and eyelid discomfort. Intra-operative findings included pseudoencapsulated, calcified, subcutaneousmasses that
were also adherent to the periosteum of the superior orbital rim (Figures 2A and 2B) but were able to be resected (Figures 2C and
2D). Pathology confirmed calcified lesions. 4months post-operatively, the patient describes an improvement in visual impairment
and decreased periorbital discomfort (Figure 3).
Conclusions:
Calcinosis has been described to occur in a variety of settings, including in associationwith autoimmune connective
tissue diseases.
1-3
With regards to calcified lesions in the periorbital region, small, subepidermal calcified nodules (SCN) of the eyelid,
most commonly in children,
4-7
and hypercalcemic stateswith lidmargin or ocular surface calcium deposits
8
have been previously
described; however, extensive calcinosis of the eyelid, including in a patient with dermatomyositis, has not been previously reported.
Management of calcification found in other parts of the bodymay include the use of systemicmedications such as colchicine or
bisphosphanates, laser therapy, intralesional steroid injections, or surgical excision.
1,2,9
In our patient, surgical excision improved
ptosis and eyelid discomfort.
References:
1. BoulmanN, SlobodinG, RozenbaumM, and
Rosner I. Calcinosis in rheumatic disease. Seminars inArthritis
and Rheumatism. 2005;34:805-812.
2. GutierrezA andWetter D. Calcinosis cutis in autoimmune
connective tissue diseases. DermatologicTherapy. 2012;
25:195-206.
3. Ladizinski B, KhanA, Sankey C. Calcinosis in adult-onset
dermatomyositis:Metastatic or dystrophic? J Gen InternMed 2013.
4. DoxanasMT, GreenWT,Arentsen JJ, Elsas FJ. Lid lesions of
childhood: a histopathologic survey at theWilmer Institute
(1923-1974). J Pediatr Ophthalmol 1976;13:7-39.
5. FerryAP. Subepidermal calcified nodules of the eyelid.
Am JOphthalmol 1990;109:85-8.
6. NicoMM, Bergonse FN. Subepidermal calcified nodule:
report of two cases and review of the literature.
Pediatr Dermatol 2001;18:227-9.
7. Nguyen J, Jakobiec F, Hanna E, FayA. Subepidermal calcified nodule of the eyelid. Ophthal Plast Reconstr Surg 2008;24:494-95.
8. LeeDK, Eiferman RA. Ocular calcifications in primary hyperparathyroidism. ArchOphthalmol 2006;124:136-7.
9. Reiter N, El-Shabrawi L, Leinweber B, et al. Calcinosis cutis: Part II.Treatment options. JAmAcadDermatol 2011.65:15-22.
DetailedProgram
—Thursday,October 16, 2014
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