Periorbital edema secondary to imatinib mesylate

Abstract

Imatinib mesylate (Gleevec((R))) is a well-established pharmacologic treatment for all phases of chronic myeloid leukemia and for advanced gastrointestinal stromal tumors (GISTs). Edema-related side effects are relatively common in imatinib therapy with the periocular skin representing one of the most common sites for localized edema. While the adverse effect of periorbital edema with imatinib is well documented in the oncology literature, there is limited reference to this common reaction in the ophthalmology literature. We report two patients with upper eyelid edema associated with imatinib therapy who required surgical intervention to ameliorate significant visual field obstruction. We highlight the details of each case including the histopathologic findings of excised redundant skin followed by a thorough review of the literature on imatinib related periorbital edema.

Keywords: edema; gleevec; imatinib mesylate; periorbital edema; tyrosine kinase inhibitor.

Figure 1

A External photograph of patient 1 preoperatively, demonstrating significant upper eyelid edema bilaterally, associated with imatinib therapy. B One-month postoperative photograph, showing marked improvement in eyelid appearance following blepharoplasty.

Figure 2

Histopathology of excised eyelid skin (H&E stain). A: Low-power view showing diffuse edema in the dermis (magnification, x20). B: At higher magnification (x200), dilated lymphatic channels (lymphangiectasia, double-headed arrows) may be appreciated. Mixed chronic inflammatory cells (block arrow) are seen, much of the inflammation occurring adjacent to hair follicles (arrows). C: Higher magnification (x600) of the area outlined by the rectangle in B). Abbreviation: H&E, hematoxylin & eosin.

Figure 3

A External photograph of patient 2 preoperatively, demonstrating significant upper eyelid edema bilaterally. B One month postoperative external photograph, showing marked improvement in eyelid appearance following blepharoplasty and ptosis repair.