Full-Thickness Eyelid Lesions in Sarcoidosis

Eyelid involvement in sarcoidosis is very rare. A search of the medical literature indicates one previous report of sarcoidosis with destructive eyelid lesions. We describe the case of a 50-year-old woman with severe systemic sarcoidosis, which included her eyelids. To our knowledge, the case presented herein represents the first to show the full-thickness histopathology of destructive eyelid lesions in sarcoidosis. 1. Introduction Sarcoidosis is a multisystem inflammatory disease of unknown etiology characterized histopathologically by noncaseating granulomas. The condition has a female predilection with a peak incidence in the 3rd and 5th decades of life. Pulmonary involvement is the most common manifestation. Common extrapulmonary manifestations include the skin, central nervous system, liver, kidney, and musculoskeletal system. Furthermore, sarcoidosis can affect the heart, peripheral nervous system, salivary glands, eye, and ocular adnexa. Ocular involvement occurs in 25%–60% of patients with systemic sarcoidosis [1, 2]. While the disease can involve any ocular tissue, anterior uveitis and lacrimal gland involvement are the most frequently reported findings [3]. Eyelid manifestations of sarcoidosis include “millet seed” nodules, ulcerated nodules, plaques, and swollen eyelids [4]. Eyelid involvement in sarcoidosis is very rare. To our knowledge, there is only one previous report in the literature that describes full-thickness eyelid involvement. Our case is the first to show the full-thickness histopathology of destructive eyelid lesions in sarcoidosis. 2. Case Report A 50-year-old female with severe systemic sarcoidosis, including pulmonary, skin, and joint disease, presented for evaluation of ocular involvement. The patient had noted eyelid nodules for over 5 years; however, she recently developed eyelid deformities, tearing, and eye irritation. On examination, she had notching of her upper and lower eyelids and extensive scarring of the posterior lamella leading to entropion and focal trichiasis (Figure 1). Slit lamp examination showed complete inspissation of the meibomian glands and superficial keratitis corresponding with misdirected eyelashes. The remainder of the anterior and posterior segment examination was within normal limits. Medical therapy did not adequately control the patient’s symptoms. Figure 1: (a) Preoperative photograph of the patient showing eyelid notching, entropion, and trichiasis. Multiple sarcoid nodules on the face are present. (b) Preoperative photograph of everted right upper eyelid showing focal trichiasis,