윗눈꺼풀 성형술로 치료한 특발성 윗눈꺼풀 부종 환자 1예
A Case of Idiopathic Upper Eyelid Swelling Treated by Upper Eyelid Blepharoplasty
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목적: 윗눈꺼풀 성형술로 치료한 스테로이드 치료에 호전되지 않는 특발성 윗눈꺼풀 부종 환자 1예를 보고하고자 한다. 증례요약: 당뇨 및 흡연력이 있는 69세 남자환자가 5년 전부터 지속된 양측 윗눈꺼풀 부종을 주소로 내원하였다. 과거에 윗눈꺼풀부종으로 전신 스테로이드 치료를 받으면 호전되었으나 스테로이드 용량을 줄이면 다시 악화되는 양상을 보였다고 한다. 내원 당시양측 윗눈꺼풀 부종이 관찰되었고 감별을 위해 시행한 혈액검사 및 컴퓨터 단층촬영에서 특이소견 보이지 않았다. 증상 조절 및 염증조절 위해 경구 스테로이드 치료를 시작하였으나 환자의 증상호소 및 윗눈꺼풀 처짐 증상 지속되어 윗눈꺼풀 성형술을 시행하였으며수술 후 증상호전을 보였다. 수술 시 시행한 조직검사에서 경한 염증소견 이외에 특이소견 관찰되지 않았다. 결론: 원인을 알 수 없는 윗눈꺼풀 부종 환자들 중 전신 스테로이드 치료에도 호전과 악화를 반복하는 경우가 있다. 본 증례를 통하여전신 스테로이드 사용에도 호전과 악화를 반복하는, 원인을 알 수 없는 윗눈꺼풀 부종 환자에서 윗눈꺼풀 성형술이 눈꺼풀 기능 및심미적으로 도움이 될 수 있으며 스테로이드 치료 중단을 가져올 수 있음을 알 수 있었다.
Abstract
Purpose: To report a case of idiopathic upper eyelid swelling with minimal response to steroid treatment treated by upper eyelidblepharoplasty. Case summary: A 69-year-old man with diabetes mellitus and smoking history, presented upper eyelid swelling in both eyesstarting 5 years ago. The patient had been receiving systemic steroid treatment for idiopathic upper eyelid swelling, though eachattempt to taper steroid treatment led to recurrence of eyelid swelling. In the initial examination, both upper eyelids showedswelling. For differential diagnosis, a work-up including laboratory test and computerized tomography (CT) scan of the orbit wereinitiated. There were no abnormalities on laboratory tests including the thyroid function test. A CT scan of the orbit wasunremarkable. For managing symptoms and inflammation, smoking was stopped and steroid treatment was administered. Thepatient still, however, complained of discomfort and swelling. To relieve symptoms and debulk inflammatory tissue, bilateral uppereyelid blepharoplasty was performed. The patient experienced reduced discomfort after the surgery. The biopsy showed noabnormalities, except for mild inflammation. Conclusions: We present a case of idiopathic upper eyelid swelling despite steroid treatment. In this case, upper eyelid blepharoplastywas used with excellent functional and cosmetic outcomes. Thus, suspension of steroid treatment in cases of patientswith recurrent eyelid swelling, in spite of steroid treatment, should be considered.
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