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Challenges in the Management of Upper Lid Keloid
Ruchi Goel1, Samreen Khanam1, Shalin Shah1
1Ophthalmology, Maulana Azad Medical College, New Delhi, India.
Case Reports in Ophthalmological Medicine
|April 4, 2022
Summary
This case study highlights successful management of recurrent eyelid keloids using a combination of surgical excision, intralesional injections, and topical therapy. Long-term follow-up confirmed no recurrence after multidisciplinary treatment.
Area of Science:
- Ophthalmology
- Dermatology
- Plastic Surgery
Background:
- Recurrent keloids pose a significant challenge in reconstructive surgery, particularly after eyelid procedures.
- Cicatricial ectropion repair using postauricular grafts can sometimes lead to keloid formation.
Observation:
- A middle-aged female developed firm, nontender masses on the left upper eyelid and behind the ear post-eyelid reconstruction.
- A similar mass was present on the right shin, leading to a diagnosis of multiple keloids.
- Initial intralesional injections of triamcinolone acetonide and 5-Fluorouracil (5-FU) into the eyelid keloid caused surface ulceration.
Findings:
- Surgical excision of the eyelid keloid, followed by 5-FU injection into the keloid bed and temporal forehead flap reconstruction, was performed.
- A postoperative wound infection with Acinetobacter baumannii occurred, treated with colistimethate sodium.
- Adjuvant topical imiquimod cream (5%) for 24 weeks resulted in no recurrence of the eyelid keloid at 16 months.
Implications:
- A multidisciplinary approach combining conservative and surgical therapies is crucial for managing complex keloid cases.
- Long-term follow-up is essential to monitor for recurrence and ensure optimal patient outcomes.
- This case demonstrates the potential efficacy of topical imiquimod as an adjuvant therapy for recalcitrant eyelid keloids.
