May 2004
Volume 45, Issue 13
ARVO Annual Meeting Abstract  |   May 2004
Spontaneous Periorbital Ecchymosis In An Atopic Patient On Chronic Topical Corticosteroid Treatment
Author Affiliations & Notes
  • A.J. Flach
    Ophthalmology, UCSF, San Francisco, CA
  • S. Carter
    Ophthalmology, UCSF, San Francisco, CA
  • E. Howes
    Ophthalmology, UCSF, San Francisco, CA
  • J.B. Crawford
    Ophthalmology, UCSF, San Francisco, CA
  • Footnotes
    Commercial Relationships  A.J. Flach, None; S. Carter, None; E. Howes, None; J.B. Crawford, None.
  • Footnotes
    Support  none
Investigative Ophthalmology & Visual Science May 2004, Vol.45, 4706. doi:
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    • Get Citation

      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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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract: : 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.

Keywords: corticosteroids • drug toxicity/drug effects • eyelid 

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