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Title

Wells syndrome as a rare cause of unilateral ptosis

Purpose	Eosinophilic cellulitis, also described as Wells syndrome, is a rare inflammatory skin disease of unknown aetiology that looks like a bacterial cellulitis. We report the case of a unilateral swollen upper eyelid with subconjunctival mass caused by Wells syndrome.
Methods	Case report
Results	A 56-year old woman presented with a 4-weeks history of a swollen upper eyelid with ptosis. It was already treated as an allergy and as a hordeolum without success. Visual acuity was 20/20 in both eyes. Biomicroscopy showed at the left eye a swollen and ptotic upper eyelid with a deeper palpable hard mass, chemosis of the bulbar conjunctiva with small subconjunctival nodules. Blood tests showed no inflammation but a relative eosinophilia (8%, 0.44 .10E9/L). Because of no clinical reaction on oral NSAID, a biopsy of conjunctiva and subcutaneous tissue of the upper eyelid was performed. Anatomopathological examination showed a large infiltration of the tissue by eosinophilic granulocytes, partial necrotic material without signs of vasculitis and a few Gram+ granules. Standard topical tobramycine-dexamethasone 4x/day and oral Amoxicille-clavulanic acid 1g 3x/dag were given for 10 days without any improvement. Then we started with 64mg of oral cortisone (Medrol) in a quick down-tapering scheme. The patient noticed some positive effects the first days, but the upper eyelid stayed in ptosis with a palpable mass. We re-increased the cortisone to 32mg and held it for 1 week before starting to taper it down, in conjunction with starting an oral antihistaminic. Slow disappearance of the swelling and hard mass was noted. Cortisone was stopped after 3 months but a slight ptosis remained.
Conclusion	Wells syndrome is a rare disease that can affect the eyelids and conjunctiva.
Conflict of interest	No

Authors 1

Last name	JANSSEN
Initials	C
Department	UZA

Authors 2

Last name	Lauwers
Initials	N
Department	UZA

Authors 3

Last name	Leysen
Initials	I
Department	UZA

Authors 4

Last name	De Keizer
Initials	RJW
Department	UZA