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Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 790-791

Idiopathic calcinosis cutis of upper eye lid in a young male


Department of Ophthalmology, Yenepoya Medical College, Yenepoya (deemed to be University), Deralakatte, Karnataka, India

Date of Submission10-Feb-2021
Date of Acceptance29-Mar-2021
Date of Web Publication09-Oct-2021

Correspondence Address:
Dr. Vidya Hegde
Yenepoya Medical College, Nithyananda Nagar, Deralakatte, Mangalore, Karnataka - 575 018
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_351_21

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  Abstract 


Keywords: Calcinosis cutis, eyelid, subepidermal calcified nodule


How to cite this article:
Hegde V, Jain R, Shambhu R, Bappal A. Idiopathic calcinosis cutis of upper eye lid in a young male. Indian J Ophthalmol Case Rep 2021;1:790-1

How to cite this URL:
Hegde V, Jain R, Shambhu R, Bappal A. Idiopathic calcinosis cutis of upper eye lid in a young male. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Oct 26];1:790-1. Available from: https://www.ijoreports.in/text.asp?2021/1/4/790/327737



Calcinosis cutis refers to a clinical condition where there is deposition of calcium in the epidermis of the skin. It is commonly seen in young individuals.[1] It often causes diagnostic challenge due to its rare occurrence and nonspecific appearance. Calcinosis cutis may be of four types: dystrophic, metastatic, iatrogenic and idiopathic. Subepidermal calcified nodule is an uncommon variant of the idiopathic type.

A 26-year-old man presented with swelling in the left upper eyelid of 2-year duration which was initially small and gradually increased in proportion to reach the present size with no history of ocular trauma [Figure 1]a. On examination, there was mechanical ptosis of the left eye. The swelling was 5 cm × 4 cm over the left upper eyelid, oval in shape, extending superiorly below the brow, laterally beyond the lateral canthus, inferiorly below the lid crease and medially 3 cm above the medial canthus. The overlying skin was erythematous with multiple yellowish colored lesions giving it a lobulated appearance. It was of varied consistency. The anterior segment and fundus were unremarkable in both the eyes. Visual acuity was 6/6 both eyes. We considered the following as differential diagnosis: lipoma, epidermal cyst of lid and pilomatrixoma. MRI imaging was done with differential diagnosis of calcinosis cutis [Figure 1]b. His serum calcium and phosphorous levels were normal. The patient underwent excision biopsy through an incision just below the brow [Figure 1]c. The mass was dissected totally and completely excised. The skin was sutured with 6-0 vicryl suture [Figure 1]d. The histopathology report suggested calcinosis cutis with foreign body giant cell response [Figure 1]e. Postoperatively on day 1, he had mild mechanical ptosis with healthy wound [Figure 1]f. He was discharged and later lost for follow up.
Figure 1: (a) Image of left eyelid swelling with mechanical ptosis. (b) MRI image showing calcific areas in the swelling. (c) Intra operative image of the swelling after complete dissection with multiple areas showing toothpaste like substance. (d) Image of excised mass with dimensions. (e) Histopathologic image showing lobules of amorphous basophilic granular calcified masses surrounded by histocytes, foam cells and foreign body multinucleated giant cells (f) Postoperative day 1 photograph with clean wound and intact sutures

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  Discussion Top


In clinical practice, we get to see a variety of conditions affecting the lids and these can be benign or malignant in nature. Calcinosis cutis is a condition presenting as a swelling, characterized by deposition of calcium in the epidermis. It may be dystrophic, metastatic, iatrogenic or idiopathic in nature. The idiopathic variety occurs in a healthy individual without any trauma or systemic illness.[2] There are few reports on calcinosis cutis of eyelid and adnexa.[1],[3],[4],[5] Our case was a young male without any systemic illness and also no preceding trauma. There was difficulty in making an accurate diagnosis in him. Imaging by MRI and histopathological examination clinched the diagnosis as calcinosis cutis of the eyelid. Excision biopsy with histopathological evaluation is the treatment of choice for this condition.

Ophthalmologists should be aware that calcinosis cutis can occur in the eyelids and should be considered in the differential diagnosis of nodular swellings of the lids.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Malki SA, Al-Faky YH, Al-Rikabi AC. Bilateral subepidermal calcifiednodule of the eyelid. Saudi J Ophthalmol 2011;25:81-3.  Back to cited text no. 1
    
2.
Samaka RM, Al-Madhani A, Hussain SO. Subepidermal calcified nodule in upper eyelid: A case report and review of the literature. Oman J Ophthalmol 2015;8:56-8.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Jun I, Kim SE, Lee SY, Kim GJ, Yoon JS. Calcinosis cutis at the tarsus of the upper eyelid. Korean J Ophthalmol 2011;25:440-2.  Back to cited text no. 3
    
4.
Koylu MT, Uysal Y, Kucukevcilioglu M, Ceylan OM, Deveci MS. Bilateral symmetrical subepidermal calcified nodules of the eyelids. Orbit 2014;33:295-7.  Back to cited text no. 4
    
5.
Bothra N, Ali MJ, Trakos N, Naik MN. Lacrimal punctal and peripunctal involvement in calcinosis cutis. Indian J Ophthalmol Case Rep2018;66:720-2.  Back to cited text no. 5
    


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