Ophthal Plast Reconstr Surg, Vol. 30, No. 1, 2014
Letters to the Editor
with Stevens-Johnson syndrome. Ophthalmology 2007;114: 1294–302. 5. Di Pascuale MA, Espana EM, Liu DT, et al. Correlation of corneal complications with eyelid cicatricial pathologies in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis syndrome. Ophthalmology 2005;112:904–12.
Epidemic Adenoviral Keratoconjunctivitis Complicated by Massive Bilateral Lower Eyelid Cysts To the Editor: Epidemic adenoviral keratoconjunctivitis (EAKC) has been reported to cause a multitude of pathologic sequelae affecting the ocular surface, including subepithelial corneal infiltrates (nummuli), corneal astigmatism, sympblephara, or even precipitation of Stevens-Johnson syndrome.1–3 Although corneal disorders generally subside overtime, the anatomical alterations affecting the conjunctiva may require corrective surgery.3 We present a case of a 46-year-old woman who developed massive lower eyelid cysts following an episode of EAKC, with a view to highlight the potential magnitude of the consequences of adenoviral infection from an oculoplastic surgeon’s standpoint. The patient presented with bilateral lower eyelid edema associated with conjunctival hyperemia and discomfort, more pronounced to the OD. The condition appeared a few weeks after an EAKC episode and gradually progressed. Anterior segment biomicroscopy was significant for cicatricial entropion and trichiasis in the OD (Fig. 1A), whereas grey-bluish
FIG. 2. Intraoperative view of the removal of the lesion from the right lower eyelid. The transforniceal procedure was combined with the placement of everting sutures and horizontal tightening of the right lower eyelid (A). Postoperative view following the removal of the lesions from both lower eyelids (B).
formations were visible at the depth of the conjunctival fornices in OU (Fig. 1B,C). MRI was significant for large cystic formations occupying the preseptal space in both lower eyelids (Fig. 1D,E). Transconjunctival surgical excision of the lesions combined with horizontal shortening of the lower eyelid with a lateral tarsal strip approach was performed under general anesthesia in OU. Everting sutures were also placed to correct entropion in the OD (Fig. 2A). The procedures were successful in correcting the deformities in OU (Fig. 2B). Histologic examination of the excised cysts revealed incarcerated epithelial lining and a thin fibrous capsule. To the best of our knowledge, this is the first report of massive inclusion cysts and cicatricial entropion requiring extensive periocular reconstructive work for the anatomical restoration of the lower conjunctival fornices and eyelid margins following an EAKC attack. Findings from this case also stress the importance of MRI studies to assess eyelid structure for cases with persistent eyelid edema, following EAKC attacks.
Efstathios T. Detorakis, M.D., Ph.D. Correspondence: Efstathios T. Detorakis, M.D., Ph.D., Department of Ophthalmology, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece ([email protected]) The author has no financial or conflicts of interest to disclose.
REFERENCES FIG. 1. A 46-year-old woman with bilateral lower eyelid edema and lower eyelid trichiasis, entropion, and conjunctival hyperemia in the OD (A). Grey-bluish formations are visible at the conjunctival fornices in OU (black arrows, B and C). Transverse and coronal T2-oriented MRI scans (white arrows, D and E, respectively) show formations with a thin wall and high intensity contents occupying the preseptal space in both lower eyelids.
82
1. Meyer-Rüsenberg B, Loderstädt U, Richard G, et al. Epidemic keratoconjunctivitis: the current situation and recommendations for prevention and treatment. Dtsch Arztebl Int 2011;108:475–80. 2. Hodge WG, Discepola MJ, Deschênes J. Adenoviral keratoconjunctivitis precipitating Stevens-Johnson syndrome. Can J Ophthalmol 1994;29:198–200. 3. Hammer LH, Perry HD, Donnenfeld ED, et al. Symblepharon formation in epidemic keratoconjunctivitis. Cornea 1990;9:338–40.
© 2014 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.
Letters to the Editor
with Stevens-Johnson syndrome. Ophthalmology 2007;114: 1294–302. 5. Di Pascuale MA, Espana EM, Liu DT, et al. Correlation of corneal complications with eyelid cicatricial pathologies in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis syndrome. Ophthalmology 2005;112:904–12.
Epidemic Adenoviral Keratoconjunctivitis Complicated by Massive Bilateral Lower Eyelid Cysts To the Editor: Epidemic adenoviral keratoconjunctivitis (EAKC) has been reported to cause a multitude of pathologic sequelae affecting the ocular surface, including subepithelial corneal infiltrates (nummuli), corneal astigmatism, sympblephara, or even precipitation of Stevens-Johnson syndrome.1–3 Although corneal disorders generally subside overtime, the anatomical alterations affecting the conjunctiva may require corrective surgery.3 We present a case of a 46-year-old woman who developed massive lower eyelid cysts following an episode of EAKC, with a view to highlight the potential magnitude of the consequences of adenoviral infection from an oculoplastic surgeon’s standpoint. The patient presented with bilateral lower eyelid edema associated with conjunctival hyperemia and discomfort, more pronounced to the OD. The condition appeared a few weeks after an EAKC episode and gradually progressed. Anterior segment biomicroscopy was significant for cicatricial entropion and trichiasis in the OD (Fig. 1A), whereas grey-bluish
FIG. 2. Intraoperative view of the removal of the lesion from the right lower eyelid. The transforniceal procedure was combined with the placement of everting sutures and horizontal tightening of the right lower eyelid (A). Postoperative view following the removal of the lesions from both lower eyelids (B).
formations were visible at the depth of the conjunctival fornices in OU (Fig. 1B,C). MRI was significant for large cystic formations occupying the preseptal space in both lower eyelids (Fig. 1D,E). Transconjunctival surgical excision of the lesions combined with horizontal shortening of the lower eyelid with a lateral tarsal strip approach was performed under general anesthesia in OU. Everting sutures were also placed to correct entropion in the OD (Fig. 2A). The procedures were successful in correcting the deformities in OU (Fig. 2B). Histologic examination of the excised cysts revealed incarcerated epithelial lining and a thin fibrous capsule. To the best of our knowledge, this is the first report of massive inclusion cysts and cicatricial entropion requiring extensive periocular reconstructive work for the anatomical restoration of the lower conjunctival fornices and eyelid margins following an EAKC attack. Findings from this case also stress the importance of MRI studies to assess eyelid structure for cases with persistent eyelid edema, following EAKC attacks.
Efstathios T. Detorakis, M.D., Ph.D. Correspondence: Efstathios T. Detorakis, M.D., Ph.D., Department of Ophthalmology, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece ([email protected]) The author has no financial or conflicts of interest to disclose.
REFERENCES FIG. 1. A 46-year-old woman with bilateral lower eyelid edema and lower eyelid trichiasis, entropion, and conjunctival hyperemia in the OD (A). Grey-bluish formations are visible at the conjunctival fornices in OU (black arrows, B and C). Transverse and coronal T2-oriented MRI scans (white arrows, D and E, respectively) show formations with a thin wall and high intensity contents occupying the preseptal space in both lower eyelids.
82
1. Meyer-Rüsenberg B, Loderstädt U, Richard G, et al. Epidemic keratoconjunctivitis: the current situation and recommendations for prevention and treatment. Dtsch Arztebl Int 2011;108:475–80. 2. Hodge WG, Discepola MJ, Deschênes J. Adenoviral keratoconjunctivitis precipitating Stevens-Johnson syndrome. Can J Ophthalmol 1994;29:198–200. 3. Hammer LH, Perry HD, Donnenfeld ED, et al. Symblepharon formation in epidemic keratoconjunctivitis. Cornea 1990;9:338–40.
© 2014 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.
![[Adenoviral keratoconjunctivitis].](/assets/img/hold.png)
