Eyelid Varix

Eyelid Varix is an abnormal dilatation of one or more normal blood vessels. Varices of the eyelids are usually an extension forward of the orbital varices into the eyelid. These probably are congenital or acquired weakness of the affected vein, or to an obstruction of the venous circulation.

Varices may result due to

• An arteriovenous malformation
• Compression by an arterial aneurysm or a tumour
• Infection
• Trauma involving wall or lumen, of the vein

Varices resulting from infection or trauma may get thrombosed.

References

Biswas Arnab. Eyelid Tumours - Clinical Evaluation and Reconstruction Techniques. Springer India 2014. P 78- 80.

Shields Jerry A, Shields Carol L. Eyelid, Conjunctival, and Orbital Tumors- An Atlas and Textbook Second Edition. Lippincott Williams & Wilkins, a Wolters Kluwer business 2008. P 146- 147.

Dutton Jonathan J, Gayre Gregg S, Proia Alan D. Diagnostic Atlas of Common Eyelid Diseases. Taylor & Francis Group, LLC 2007. P 257- 258.

Older Jay Justin. Eyelid Tumors – Clinical Diagnosis & Surgical Treatment Second Edition. Manson Publishing Ltd 2003. P 12

Bowling Brad. Kanski’s Clinical Ophthalmology- A Systematic Approach Eighth Edition. Elsevier 2016. P 51.

Pasquali Paola. Cryosurgery – A Practical Manual. Springer- Verlag Berlin Heidelberg 2015. P 135.

Othman Ihab Saad. Ophthalmic pathology interactive with clinical correlation. Kugler Publications, Amsterdam, The Netherlands, Ihab Saad Othman 2009. P 36.

Mannis Mark J, Holland Edward J. CORNEA – Fundamentals, Diagnosis and Management Fourth Edition. Elsevier Inc. 2017. P 325.

https://www.ncbi.nlm.nih.gov/pubmed/20724862

Eyelid varix may present with symptoms such as

• Soft brown or blue lesion which increases with increase in venous pressure
• Organised thrombus may show haemosiderin and calcification
• Ruptured varix may show haemorrhage and lid ecchymosis
• Haemorrhage in deep associated orbital varix may present with acute pain, proptosis and restriction of ocular movements.

Eyelid varix is caused probably due to congenital or acquired weakness of the involved vein, or due to obstruction of the venous circulation.

Eyelid varices may result due to

• An arteriovenous malformation
• Compression by an arterial aneurysm or a tumour
• Infection
• Trauma involving wall or lumen of the vein

Diagnosis of eyelid varix is clinical.

Eyelid varix is a well defined soft dark blue or brown lesion without any associated palpable thrill or bruit. The lesion increases in size with any activity which raises venous pressure such as Valsalva manoeuvre.

Some cases with organised thrombus may be associated with haemosiderin deposition or dystrophic calcification. The lesion is firm in consistency and less compressible in thrombosed lesions. Varices may get ruptured with minor trauma, resulting in haemorrhage and lid ecchymosis.

In cases with orbital extension, deep haemorrhage may result in onset of acute pain, proptosis and restriction of ocular movements.

Pathology

Grossly, eyelid varix lies anterior to septum. Deep orbital varix may produce proptosis.

Microscopically, varix shows dilated vascular channels, filled with clotted blood and focal thrombosis. There may be phlebolith formation.

Investigations

CT scan: Since most of eyelid varices may have orbital extension, a CT scan may be needed in those with orbital clinical signs.

Differential diagnosis

It includes

• Capillary haemangioma
• Cavernous haemangioma
• Arteriovenous malformation
• Lymphangioma
• Dacryocele

Eyelid varices may be just observed and followed up in most of the cases.

It is possible to treat a small varix just like haemangioma with a precooled probe when applied with little pressure.

Ectatic periocular veins may be tried with sclerotherapy.

Surgical therapy

Patient with eyelid dysfunction or requiring cosmetic correction may undergo surgical excision.