An unusual presentation of a lid varix

A varix usually refers to any abnormally distended vein, artery, or lymphatic vessel. Although orbital varices are a common finding, isolated eyelid varices are rare. Orbital and lid varices may be associated with additional venous malformations elsewhere in the body. The varices can be induced by the Valsalva maneuver that leads to increased pressure on the jugular vein. Because of the passive nature of the venous system, varices can also be induced by prone posture or stooping. Patients with ophthalmic varices may present with proptosis or complain of visual disturbance.

A 39-year-old Asian woman presented to our clinic for a comprehensive eye examination, with complaints of discomfort while lying down, bending, or crying. She experienced a sensation of fullness in the right upper eyelid that seemed to have worsened gradually over the prior 9 years since her last pregnancy. Lid examination found a firm, palpable, nontender mass present within the right superior nasal lid after stooping. When filled, the induced lid mass could be visualized by ultrasound scan. The mass resolved when the patient sat upright.

Lid varices are rare and usually visually benign. Ligation of small sections of the varix, as appropriate, may achieve the desired cosmetic effect and improve patient comfort. The varix usually does not recur after removal. Venography is used to evaluate the extent and supply of the varix before surgery. Cavernous hemangioma, a similar presentation, should be differentiated as it carries significant visual morbidity. Careful differential diagnosis with magnetic resonance imaging and computed tomography is essential with a new-onset or spontaneous varix.