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A.J. Flach, S. Carter, E. Howes, J.B. Crawford; Spontaneous Periorbital Ecchymosis In An Atopic Patient On Chronic Topical Corticosteroid Treatment . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4706.
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Purpose: We report a case of nocturnal spontaneous periorbital ecchymosis in an atopic patient receiving chronic treatment with topically applied periocular corticosteroids. These clinical observations are correlated with histologic examination of pathologic specimens. Methods: A 56 year old man with chronic periocular atopic dermatitis treated with 0.025% fluocinolone acetonide ointment for over two decades suddenly developed the onset of a painful , spontaneous periocular hemorrhage awakening him from his sleep. There was no decrease in visual acuity or elevation of intraocular pressure and there was no history of migraine or trauma. The patient was taking 80 mg of aspirin and 500 mg ascorbic acid daily. Results: Following complete ophthalmic examinations and multiple consultations from experts specializing in orbital tumors, neuro–ophthalmology and external eye diseases, multiple periocular biopsies were taken by an ophthalmic plastic surgeon and submitted for evaluation by a group of pathologists. Histologic examination revealed eyelid atrophy and neovascular changes consistent with chronic topical steroid treatment. There was no evidence of vascular abnormalities including arteriovenous fistula or malformation, orbital lymphangioma or ocular neuroblastoma. Evidence of granulomatous dermatitis secondary to follicular rupture was present in many of the histologic specimens. Conclusions: This patient experienced marked periorbital ecchymosis induced by relatively minor local trauma while asleep without the presence of coexistent vascular abnormalities. The involved eyelid was predisposed to spontaneous hemorrhages by chronic topical corticosteroid use and the coexistent ingestion of aspirin and ascorbic acid.
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