‘Spontaneous haemorrhage in an eyelid hidrocystoma in a patient treated with clopidogrel’ by Tehrani et al

Sir,

We thank Tehrani et al¹ for their interest in our article² and for sharing their experience of two cases of spontaneous hemorrhage in an apocrine hidrocystoma in patients on antiplatelet therapy.

We challenge their assertion that spontaneous bleeding within a hidrocystoma may occur even in the absence of clopidogrel use, because both of their patients were on clopidogrel, as in our case. Furthermore, they have provided no references to support that view. Although this is difficult to prove, we believe that the antiplatelet activity of clopidogrel contributed to the spontaneous bleeding within the hidrocystoma in our patient, as well as their two cases. However, the risk of spontaneous bleeding within a hidrocystoma may not be unique to clopidogrel, and could apply to other antiplatelet agents. Interestingly, one of their patients was on concurrent aspirin therapy but there are no reports to date of spontaneous hemorrhage in a hidrocystoma related solely to aspirin use.

We have no reason to believe that spontaneous bleeding within an eyelid hidrocystoma is a common phenomenon, as there are no other reports in the medical literature. Tehrani et al’s report of two additional cases does nothing to alter the fact that this is a rare phenomenon.