Localised vasculitis - an uncommon cause of an unilateral persistent blepharoedema

To report on the rare case of a localised small-vessel vasculitis causing persistent blepharoedema. A 58-year old woman presented with sudden occurrence of a severe, unilateral blepharoedema. Extended serological examination, orbital CT, and MRI were normal; sonography showed slight thickening of the lateral rectus muscle. Under treatment with higher dosed steroids, the swelling of the lid vanished, but relapsed when the therapy was gradually reduced. Biopsy revealed florid vasculitis of the small vessels in the orbital soft tissue. No signs of systemic manifestation were found. Our patient presented with a localised, eosinophilic vasculitis of the small orbita vessels, a very rare cause of blepharoedema. In the literature only three cases with a localised eosinophilic vasculitis have been reported previously. Early diagnostic biopsy is recommended in such cases of persistent blepharoedema.