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JAMA Ophthalmology Clinical Challenge
October 15, 2020

Bilateral Atypical Eyelid Lesions in a 50-Year-Old Woman

Author Affiliations
  • 1Stanford University School of Medicine, Stanford, California
  • 2Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, California
JAMA Ophthalmol. Published online October 15, 2020. doi:10.1001/jamaophthalmol.2020.2090

A 50-year-old woman was referred to the oculoplastic clinic for evaluation of bilateral vascular lesions of the eye visible beneath the palpebral conjunctivae on the upper and lower eyelids. She denied any vision changes or pain but did report a sensation of pressure in the location of the lesions, which was relieved when prone. She had a 25-year history of bulimia and was purging almost daily. She reported an inability to go more than 3 days at a time without purging and noted a reduction in the pressure and size of her lesions with respite from these daily episodes. She had no history of eye surgery, hypertension, atherosclerotic disease, or other risk factors for vascular disease. The patient first noticed these lesions 15 years ago in association with a subconjunctival hemorrhage on the left side. An orbital magnetic resonance image obtained at the time of that episode demonstrated a 2 × 0.6-cm focus of enhancement along the inferior and inferolateral palpebral tissues anterior to the left globe, suggestive of lymphangioma, hemangioma, or vascular malformation without other focal abnormalities. The anterior segment examination showed bilateral superior (Figure, A) and inferior (Figure, B) large dilated blood vessels underlying the palpebral conjunctivae. Complete ophthalmic and orbital examinations revealed no other abnormalities.

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