J Korean Ophthalmol Soc.  2020 Aug;61(8):944-949. 10.3341/jkos.2020.61.8.944.

Severe Upper and Lower Tarsal Ectropion with Immunoglobulin G4-related Ophthalmic Disease

• Oh JH
• Son BJ

• KMID: 2505315
• DOI: http://doi.org/10.3341/jkos.2020.61.8.944

Abstract

Purpose
To present the first case of severe upper and lower tarsal ectropion associated with immunoglobulin G4 (IgG4)-relatedophthalmic disease.
Case summary
A 37-year-old male presented with relapsed eyelid swelling and periocular inflammation in the left eye for7 years. He had severe upper and lower tarsal ectropion and a thickened upper eyelid with prolapsed conjunctival fornix. Orbitalcomputed tomography showed a poorly defined anterior orbital mass involving the lacrimal gland and upper and lower eyelids onthe left eye. The severe upper and lower eyelid ectropion was corrected by a modified spindle procedure and lateral tarsal strip.Hard, ill-defined fibrotic tissue and a mass around the lateral upper tarsal plate were discovered that required excision of themass and a biopsy. Hematologic and histopathologic findings of the orbital mass indicated IgG4-related ophthalmic disease withsevere upper and lower ectropion caused by the disease.
Conclusions
In cases of severe upper and lower eyelid ectropion caused by chronic inflammation, as seen in this case, not onlyeyelid tightening with excision of the causative mass but also a modified spindle procedure is required to prevent rotation of theeyelid.

Keyword

Immunoglobulin G4-related ophthalmic disease; Modified spindle procedure; Upper and lower eyelid ectropion