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Lid retraction in primary hepatocellular carcinoma
  1. ALISON MEADOWS,
  2. MATHEW RAYNOR,
  3. ANDREW LUFF
  1. Southampton Eye Unit
  1. Mr Andrew Luff, Southampton Eye Unit, Southampton SO16 6YD

https://doi.org/10.1136/bjo.85.6.754-a

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    Editor,—We report an unusual case of severely symptomatic lid retraction with secondary corneal exposure in a patient with terminal hepatocellular carcinoma and no evidence of thyroid orbitopathy.

    CASE REPORT

    A 69 year old woman attending the eye clinic with primary open angle glaucoma complained of a 2 month history of sore eyes. She was already using gel tears for dry eyes, in addition to betaxolol and latanoprost for her glaucoma. Visual acuities were 6/9 in each eye unaided, improving to 6/6 with a pinhole. On examination she had marked bilateral, symmetrical lid retraction, lid lag, and some mild punctate corneal epithelial staining. She had no other features suggestive of thyroid orbitopathy, or of generalised thyroid dysfunction and no goitre. Her free thyroxine and thyroid stimulating hormone were normal.

    Eight months earlier she had presented with a large epigastric mass and was found to have advanced primary hepatocellular carcinoma. She had a raised alkaline phosphatase (930 IU/l) and alanine aminotransferase (169 IU/l) and an iron deficient anaemia (haemoglobin 91g/l). Hypercalcaemia (corrected serum calcium …

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