Mechanical Ptosis as the Initial Presentation of Eosinophilic Granulomatosis with Polyangiitis

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare ANCA-associated small-vessel vasculitis that may involve the orbit. Dacryoadenitis presenting as unilateral mechanical ptosis is an unusual ophthalmic manifestation that may mimic inflammatory or neoplastic orbital disease.

A 68-year-old man presented with unilateral eyelid swelling and lacrimal gland enlargement associated with orbital inflammation. Orbital imaging demonstrated dacryoadenitis. Systemic evaluation revealed a history of childhood asthma, chronic rhinosinusitis, mononeuritis, positive p-ANCA serology, and lacrimal gland histopathology demonstrating eosinophilic-rich inflammation consistent with EGPA. The patient was treated with systemic corticosteroids, with favorable clinical improvement.

Unilateral dacryoadenitis is a rare manifestation of eosinophilic granulomatosis with polyangiitis and should be considered in the differential diagnosis of orbital inflammatory disease. Early recognition may facilitate prompt systemic treatment and improved clinical outcomes.