Comment on ‘Spontaneous haemorrhage in an eyelid hidrocystoma in a patient treated with clopidogrel’

Abstract

A 66-year-old man diagnosed with ODP was examined with an SS-OCT instrument (DRI OCT-1, Topcon, Tokyo, Japan). The patient had visual disturbances in his left eye, and his best-corrected visual acuity was 1.2 OD and 0.7 OS. The intraocular pressure was 14 mm Hg OU. Slit-lamp examination of both eyes and fundus examination of the right eye were unremarkable. Fundus examination of the left eye showed an ODP with macular retinoschisis (Figure 1). SS-OCT clearly delineated the SAS and its direct communication with the vitreous cavity (Figure 2). The opening in the optic disc became clearly visible by a three-dimensional OCT reconstruction. Perimetry showed no glaucomatous visual field defects. Brain and orbital magnetic resonance imagings were normal. CommentIn our case, the macular retinoschisis was most likely the cause of the visual impairment. The schisis formation is the initial step in the evolution of serous retinal detachments associated with ODPs. 2,3 Krivoy et al 2 suggested that the ODP acts as a conduit for fluid flow between the SAS and the schisis cavity or subretinal space. In our case, SS-OCT delineated a thin line of fluid in the disc that was presumably connected to the SAS.Ohno-Matsui et al 1 reported that SAS could be seen by SS-OCT in 93.2% of highly myopic eyes. They described that an SAS was seen as a hyporeflective space around the optic nerve. In one myopic patient, there was a direct communication between the SAS and the vitreous cavity. 1 In ODP, previous reports only inferred that there were direct communications among the SAS, vitreous cavity, and subretinal space. [3][4][5] Kuhn et al 5 reported a case of ODP in whom intravitreally injected silicone oil was detected intracranially indicating a communication between the SAS and the vitreous cavity. Our findings demonstrated a direct communication between the SAS and the vitreous cavity in an eye with an ODP. Conflict of interestThe authors declare no conflict of interest. We read with interest the article on 'Spontaneous haemorrhage in an eyelid hidrocystoma in a patient treated with clopidogrel' by Novitskaya et al. 1 We agree with the authors that eyelid apocrine hidrocystomas typically present as skin-colored, translucent lesions. However, our experience has shown that hemorrhagic hidrocystomas may be more common than previously reported, with or without a history of clopidogrel use. Here, we describe two cases of hemorrhagic apocrine hidrocystomas. Both of the hidrocystomas underwent excision and pathologic examination.A 78-year-old male with a history of coronary artery disease on systemic clopidogrel and aspirin presented for evaluation for a non-painful, pigmented eyelid lesion. The patient was uncertain of the exact time of onset of the lesion, but felt that it was stable for the past 2 months. He denied any preceding trauma to the periocular tissue. Examination revealed a translucent dome-shaped cystic lesion along the left upper eyelid (Figure 1a). Detailed examination revealed a horizontal, linear demarcation suggestive of lay...