Mauriello J A, Lambert W C, Mostafavi R
Department of Ophthalmology, UMDNJ-New Jersey Medical School, Newark, USA.
Ophthalmic Plast Reconstr Surg. 1996 Jun;12(2):141-5. doi: 10.1097/00002341-199606000-00011.
A superficial (dermal) granuloma annulare (GA) of the eyelid developed in a 69-year-old woman who initially had no evidence of precipitating causes, including trauma, tuberculosis, octopus bite, lupus vulgaris, actinic damage, sarcoidosis, diabetes mellitus, rheumatoid arthritis, systemic lupus erythematosus, or rheumatic fever. She later developed complete bilateral nasolacrimal duct obstruction that led to dacryocystorhinostomy on the right side. Systemic workup showed evidence of a lupus-like syndrome. Although deep, subcutaneous GAs have been reported in the periocular tissues, episclera, and orbit in children and young adults, a superficial dermal GA of the eyelid in an elderly patient is distinctly rare. The characteristic histopathologic feature of both superficial and deep GAs is a necrobiotic granuloma in which necrotic collagen is surrounded by a zone of histiocytes and fibroblasts. This case demonstrates that superficial GA of the eyelid may be associated with an underlying lupus-like syndrome. This case also raises the question of whether GA of the eyelid and lupus erythematosus may be associated with bilateral nasolacrimal duct obstruction.
一名69岁女性眼睑出现浅表（真皮）环状肉芽肿（GA），最初没有发现包括外伤、结核、章鱼咬伤、寻常狼疮、光化性损伤、结节病、糖尿病、类风湿关节炎、系统性红斑狼疮或风湿热等诱发因素的证据。她后来出现双侧鼻泪管完全阻塞，导致右侧进行了泪囊鼻腔吻合术。全身检查显示有狼疮样综合征的证据。尽管儿童和年轻人的眼周组织、巩膜表层和眼眶曾有深部皮下GA的报道，但老年患者眼睑的浅表真皮GA极为罕见。浅表和深部GA的特征性组织病理学特征是坏死性肉芽肿，其中坏死的胶原被组织细胞和成纤维细胞区包围。本病例表明，眼睑浅表GA可能与潜在的狼疮样综合征有关。该病例还提出了眼睑GA和红斑狼疮是否可能与双侧鼻泪管阻塞相关的问题。
