title: Discoid lupus erythematosus of the periorbita: clinical dilemmas, diagnostic delays.
abstract: OBJECTIVE
  Untreated periocular discoid lupus erythematosus (DLE), though very rare, may lead to significant morbidity with lid deformities, trichiasis, and symblepharon formation. We present the largest reported cohort of patients with biopsy-proven DLE solely affecting the periorbital region.
  
  
  METHODS
  Observational case series of patients managed over a 7-year period (2004-10).
  
  
  RESULTS
  Seven patients (one male) presented to the Adnexal Service at Moorfields Eye Hospital at a median age of 47 years (range 23-71 years); median interval from symptom onset to biopsy-proven diagnosis was 38 months (range 6-86 months). Changes in peripheral skin were present in 1 patient (occurring after the initial eyelid presentation) and the presenting periocular features were dissimilar across the group, these included: chronic blepharo-conjunctivitis, madarosis, atypical chalazia, depigmentation of the eyelid margin, or marked, persistent periocular oedema with dacryoadenitis.Two cases settled spontaneously, but five required systemic hydroxychloroquine or intralesional corticosteroid injections.
  
  
  CONCLUSIONS
  Periorbital DLE is rare and very varied in its presentation, the protean manifestations often resulting in significant diagnostic delay. All patients with unusual periocular skin disease and those with a refractory inflammatory dermopathy, should undergo biopsy of involved tissue(s), thus leading to earlier diagnosis and prevention of permanent cicatricial periocular changes.
authors.affiliation: Adnexal Department, Moorfields Eye Hospital, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Gupta
authors.forename: M
authors.initials: M
authors.lastname: Beaconsfield
authors.forename: G E
authors.initials: GE
authors.lastname: Rose
authors.forename: D H
authors.initials: DH
authors.lastname: Verity
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D008137:Longitudinal Studies; D008179:Lupus Erythematosus, Discoid / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D004791:Enzyme Inhibitors; D006886:Hydroxychloroquine