Eyelid Calcinosis Cutis in a Child With Chronic Vernal Keratoconjunctivitis: A Case Report and Review of the Literature.

PURPOSE: To describe multifocal eyelid margin and canthal calcinosis cutis in a child with chronic recalcitrant vernal keratoconjunctivitis (VKC), and to review the reported ophthalmic cases of periocular calcinosis cutis.

METHODS

The clinicopathological data of a 14-year-old immunocompetent boy with a 9-year history of chronic VKC and inconsistent treatment adherence were reviewed retrospectively. Eyelid-margin papules and a gelatinous canthal mass were excised and examined by light microscopy with hematoxylin and eosin and with calcium-specific staining. A PubMed/MEDLINE review of periocular calcinosis cutis and subepidermal calcified nodules was additionally conducted, and individual patient data were synthesized.

RESULTS

Histopathology showed keratinized stratified squamous epithelium with epithelial atrophy; the stroma contained calcific lobules, focal metaplastic ossification, and hyaline-fibrinoid degeneration, with calcium confirmed on Von Kossa and Alizarin red staining. Immunosuppression and dysmetabolic states were excluded (HIV, HBsAg, HCV negative; serum calcium and phosphate normal). After tacrolimus withdrawal, the right canthal mass enlarged over 6 months and produced mechanical ptosis, prompting definitive excision with cryotherapy. Best-corrected visual acuity improved from 20/200 to 20/80 and from 20/50 to 20/30, with resolution of ptosis, remission of VKC, and no recurrence. Across the 12 reported cases and the present one, all were painless upper lid nodules in healthy young patients, cured by excision; none occurred in VKC.

CONCLUSIONS

Eyelid dystrophic calcification, or calcinosis cutis, is diagnosed histopathologically and cured by excision and can arise in chronic poorly controlled VKC. Sustained Th2-driven inflammation with repeated low-grade injury to the lid margin and tarsus is the most plausible mechanism; calcinosis cutis warrants consideration when a child with long-standing VKC develops firm lid margin papules or a canthal mass.