Spontaneously Resolving Periocular Erythema and Ciliary Madarosis Following Intra-arterial Chemotherapy for Retinoblastoma

Abstract

Purpose and design: To describe an unusual clinical finding seen in children undergoing intra-arterial chemotherapy for retinoblastoma.

Materials and methods: A retrospective review of 69 eyes of 63 patients receiving intra-arterial chemotherapy over a 3-year period. Charts and photographs of 69 consecutive cases were reviewed, and data were collected on patients with clinical evidence of a hyperemic cutaneous periocular abnormality following the procedure.

Results: A blanching erythematous and edematous patch was noted in the periocular region in 16% (11 of 69) of the children who received intraarterial chemotherapy. The plaque extended into the region of the supertrochlear and medial marginal artery distribution on the ipsilateral side of the intra-arterial chemotherapy. All patches of erythema spontaneously resolved within 3 months following completion of the intra-arterial chemotherapy.

Conclusion: Periocular erythema and swelling is a self-limited clinical finding associated with intra-arterial chemotherapy in a small number of patients.

Keywords: Cancer; Eye; Intra-Arterial Chemotherapy; Melphalan; Retinoblastoma; Skin; Topotican.

Figure 1

Ophthalmic artery angiogram of the left orbit, lateral, and posterior/anterior views

Figure 2

Hyperemic cutaneous periocular abnormality following intra-arterial chemotherapy for retinoblastoma. (a) Note the geographic erythematous plaque in the cutaneous area supplied by the supratrochlear and medial palpebral artery, also note the loss of the upper medial eyelashes. (b) See that the skin blanches with pressure. (c) Same patient 3 months following her last intra-arterial treatment. Note the resolution of the skin changes and eyelash loss