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Case Reports and Small Case Series
November 1998

Eyelid Neuroma Associated With Swim Goggle Use

Arch Ophthalmol. 1998;116(11):1537-1538. doi:

The use of plastic swim goggles has been associated with several complications including supraorbital neuralgia, periorbital leukoderma, contact dermatitis, and even traumatic ruptured globe.1,2 Others have reported on the "competition swimmer's eyelid syndrome," a pseudobaggy eyelid localized to the medial part of the superior eyelid.3 The authors described 2 young, competitive swimmers with localized swelling of the upper eyelid related to their use of swim goggles. The report did not include microscopic analysis of the involved tissue, and the authors believed that the swelling was due to microtrauma from the rims of the plastic goggles.

We report our experience with the swimmer's eyelid syndrome as well as histopathologic analysis from one patient. It appears that traumatic neuroma is the cause of the mass effect in swimmer's eyelid.

Report of a Case

A 22-year-old man had a 5-year history of bilateral upper eyelid masses, which was worse on the right side. The patient had been in competitive swimming for 9 years and used hard plastic swim goggles. He denied any previous episodes of facial or ocular trauma. An ophthalmic examination of visual acuity, pupillary response, and extraocular movements, as well as slitlamp examination showed no abnormalities. An external examination revealed bilateral, sub-brow nodules, located in the area of the supraorbital notch, with the right nodule being larger than the left (Figure 1). No point tenderness was elicited. Excision of the right nodule was performed under local anesthesia, and there was no numbness or paresthesia in the distribution of the fifth cranial nerve, first division, either before or after surgical treatment. Histopathologic analysis revealed a haphazard proliferation, including all elements of nerve fascicles: axons, myelin, Schwann cells, and fibroblasts (Figure 2). After 12 months the eyelid is without clinical recurrence.

Figure 1.
A firm mass, 7×9 mm, in right upper eyelid of our patient. Skin change occurs (arrow) at site where edge of goggle contacts skin.

A firm mass, 7×9 mm, in right upper eyelid of our patient. Skin change occurs (arrow) at site where edge of goggle contacts skin.

Figure 2.
Left, View of representative nerve fascicles including axons with their investiture of myelin, Schwann cells, and fibroblasts, including perineurium, captured in section (hematoxylin-eosin, original magnification ×40). Right, High-power view of the same area (hematoxylin-eosin, original magnification ×200).

Left, View of representative nerve fascicles including axons with their investiture of myelin, Schwann cells, and fibroblasts, including perineurium, captured in section (hematoxylin-eosin, original magnification ×40). Right, High-power view of the same area (hematoxylin-eosin, original magnification ×200).

Comment

Amputation, or traumatic, neuroma of the eyelid has been described in one previous report.4 Neuroma developed in the patient after a blunt periorbital trauma with a rock, which resulted in swelling and ptosis of the affected eyelid. Traumatic neuroma is most often seen after surgical or traumatic transection of peripheral nerves, and has also been reported in the orbit,5 hand, foot, face, vagina, pancreas, and bile duct. Neuromas involving the orbit are rare and usually have been associated with orbital surgery or enucleation. Traumatic neuromata from blunt trauma are far less common than from penetrating injury or surgery.

In our practice we have seen at least 3 cases of young competitive swimmers with upper eyelid swelling and a nodule localized to the medial sub-brow region. We believe this syndrome is caused by the use of nonpadded, hard plastic swim goggles (Figure 3). Our case illustrates at least one pathologic lesion associated with this clinical entity. This interesting finding warrants further investigation via microscopic analysis of all surgical specimens obtained from patients with competitive swimmer's eyelid syndrome. Treatment for this entity may consist of switching to a more padded style of goggle, discontinuation of goggle use, or surgical excision of the affected tissue.

Figure 3.
The fit of the nonpadded, Swedish-style swim goggles used by our patient.

The fit of the nonpadded, Swedish-style swim goggles used by our patient.

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Article Information

This work was supported in part by an unrestricted grant from Research to Prevent Blindness Inc, New York, NY (Dr Dailey), and by a grant from the Lester T. Jones endowed chair in Oculoplastics, Portland, Ore (Dr Wobig).

Corresponding author: Roger A. Dailey, MD, Casey Eye Institute, 3375 SW Terwilliger Rd, Portland, OR 97201.

References
1.
Jonasson  F Swimming goggles causing severe eye injuries. BMJ. 1977;1881Article
2.
Jacobson  RI More "goggle headache": supraorbital neuralgia. N Engl J Med. 1983;3081363
3.
Rubin  JMMallem  M La paupière du nageur de compétition. J Fr Ophtalmol. 1995;18426- 434
4.
Glasgow  BJVinters  HVFoos  RY Traumatic neuroma of the eyelid associated with ptosis. Ophthal Plast Reconstr Surg. 1990;6269- 272Article
5.
Messmer  EPCamara  JBoniuk  MFont  RL Amputation neuroma of the orbit: report of 2 cases and review of the literature. Ophthalmology. 1984;911420- 1423Article
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