Image of the Week Follow Up

Thanks again to everyone who participated this week.

This picture is of a pre-orbital hematoma which is seen when the capillaries around the eye are damaged.

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In a patient with tongue swelling and no history of trauma, this is concerning for amyloid purpura secondary to AL-amyloidosis. The differential diagnosis includes traumatic (particularly basal skull fractures), soft tissue injuries, and facial fractures.

In amyloidosis, this is a rare finding that typically occurs above the nipple line and is often seen in the webbing of the neck, the face, and the eyelids. Acquired Factor X deficiency, resulting from the binding of factor X to amyloid fibrils, is thought to be one cause of the spontaneous bleeding that may occur in patients with amyloidosis.

There is a differential diagnosis for eye lid discolouration:

This is a heliotrope rash secondary to dermatomyositis, an inflammatory myopathy:

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The picture below is of blepharitis. A chronic eyelid inflammatory disorder typically caused by blocked meibomian glands and secondary bacterial infection.

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Finally, this picture is of orbital cellulitis. This is a can’t miss diagnosis as it can represent a serious impending CNS infection.

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And with that I’ve looked at enough red eyes for quite some time. Have a great weekend.

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