Purpose

To present the case of a 58-year-old woman who attended the outpatient department with mechanical bilateral blepharoptosis of unknown etiology. A final diagnosis of Eosinophilia Granulomatosis with Polyangiitis (EGPA) was established.

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Methods

A 58-year-old woman presented to the outpatient department with bilateral blepharoptosis. She had a known history of chronic upper respiratory disease. Upon clinical examination, eyelid eversion revealed multiple bilateral conjunctival granulomas. Visual acuity and the remainder of the clinical evaluation were unremarkable. The patient underwent laboratory testing for sarcoidosis, granulomatosis with polyangiitis, systemic lupus erythematosus, and rheumatoid arthritis, all of which were negative. Subsequently, surgical excision of the lesions with bilateral upper eyelid biopsy was performed in order to exclude malignancy.

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Results

Histopathological examination demonstrated chronic eosinophil-predominant granulomatous inflammation. Following, rheumatology consultation and comprehensive laboratory investigation revealed positive myeloperoxidase (MPO-ANCA) antibodies. Upon clinical and laboratory evaluation, a diagnosis of EGPA was established according to the American College of Rheumatology Criteria. Due to minimal clinical response to systemic corticosteroids, she has been receiving combination therapy with mycophenolate mofetil and benralizumab during the past year; therefore, good control of her respiratory disease and complete resolution of the eyelid granulomas was observed.

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Conclusion

This case represents a rare eyelid manifestation of EGPA and highlights the importance of eyelid biopsy in the diagnosis of systemic disease.Clinicians should remain aware that ocular manifestations may occasionally represent the first sign of an underlying systemic disease, as demonstrated in our case of EGPA. Although ocular involvement in EGPA is uncommon, further research is warranted to better clarify its association with the disease, particularly as an increasing number of case reports are being published in the scientific literature.

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Additional Authors

First name	Last name	Base Hospital / Institution
Eleni	Pogka	1st University Eye Clinic, General Hospital of Athens G.Gennimatas
Maria	Theofilatou	1st University Eye Clinic, General Hospital of Athens G.Gennimatas
Athanasia	Plakopiti	1st University Eye Clinic, General Hospital of Athens G.Gennimatas

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