Eyelid Mass Research Articles

Syringocystadenoma Papilliferum in the Medial Canthus of an Eyelid

Purpose: To report a rare case of syringocystadenoma papilliferum occurring in the medial canthal area.Case summary: A 74-year-old female presented with a growing mass on the nasal side of the right eye for the past 3 months. The mass, measuring approximately 5.0 mm in central diameter, was located on the inner aspect of the right eyelid and was ulcerated. An excisional biopsy was performed, and the histopathological examination revealed a lesion characterized by exophytic squamous epithelial hyperplasia with central invagination forming a crater-like structure. The lesion had a bilayer configuration, with cuboidal basal cells in the periphery and columnar luminal cells on the inside. These findings were consistent with the diagnosis of syringocystadenoma papilliferum.Conclusions: Syringocystadenoma papilliferum was diagnosed in an eyelid mass, emphasizing the need to consider this condition in the differential diagnosis of eyelid masses given the diverse clinical manifestations associated with syringocystadenoma papilliferum.

Sweat gland tumor: A rare diagnosis of eyelid mass- A case report

Eccrine acrospiroma or Nodular hidradenomas are extremely rare sweat gland tumors of eyelid that arise as intradermal nodules from eccrine sweat glands. This case reports documents evaluation of a nodular mass of upper eyelid and its adequate management. Clinical examination followed by wide local excision and histopathologic evaluation of mass was done. Clinically, the mass was diagnosed as sebaceous cell carcinoma of eyelid. Post-operative histopathologic evaluation of the mass was suggestive of benign acrospiroma. Sweat gland tumors constitute of a very small proportion of eyelid tumors which often mimic other malignant tumors of eyelid.

Pathological findings in enucleated eyes of patients with neurofibromatosis type 1: report of a case with 15-year follow-up and review of 14 patients in the literature

BackgroundsIris nodules are frequently noted as clinical manifestations of neurofibromatosis type 1 but the other intraocular manifestations are rare. The purpose of this study is to present a patient with a phthisic eye who underwent enucleation for a cosmetic reason after 15-year follow-up and also to review 14 patients with enucleation described in the literature.Case presentationA 17-year-old man with neurofibromatosis type 1 from infancy underwent the enucleation of phthisic left eye and also had the resection of eyelid subcutaneous mass lesions on the left side for a cosmetic reason. He had undergone four-time preceding surgeries for eyelid and orbital mass reduction on the left side in childhood and had developed total retinal detachment 10 years previously. Pathologically, the enucleated eye showed massive retinal gliosis positive for both S-100 and glial fibrillary acidic protein (GFAP) in the area with involvement of the detached retinal neuronal layer, together with a more fibrotic lesion along the choroid which were, in contrast, negative for both S-100 and GFAP. The choroid, ciliary body, and iris did not show apparent neurofibroma while episcleral neurofibroma was present.Literature reviewIn review of enucleated eyes of 14 patients in the literature, buphthalmic eyes with early-onset glaucoma on the unilateral side was clinically diagnosed in 9 patients who frequently showed varying extent of hemifacial neurofibromatosis which involved the eyelid and orbit on the same side. Pathologically, neurofibromas in varying extent were found in the choroid of 12 patients. One patient showed choroidal malignant melanoma on the left side and fusiform enlargement of the optic nerve on the right side suspected of optic nerve glioma. The phthisic eye in another patient showed massive retinal gliosis similar to the present patient.ConclusionsIn summary of the 15 patients with neurofibromatosis type 1, including the present patient, buphthalmic or phthisic eyes with no vision were enucleated for cosmetic reasons and showed choroidal neurofibroma in most patients and massive retinal gliosis in two patients including the present patient.

A 5-Year Clinical Experience of Pediatric Ophthalmic Ambulatory Surgery Under General Anesthesia From a Chinese Tertiary Children's Hospital

PurposeAmbulatory surgery (same-day or day surgery) is an efficient medical practice. However, there were few reports regarding the safety of ophthalmic ambulatory surgery for children under general anesthesia. This study aims to explore its clinical complications. DesignA retrospective observational study. MethodsThe clinical data of pediatric patients who received ambulatory ophthalmic surgery under general anesthesia at the Children’s Hospital of Fudan University from January 2015 to December 2019 were analyzed retrospectively. Postoperative complications, unplanned reoperation, delayed discharge, and other adverse events were analyzed. FindingsConsecutive patients (N = 4,616) had an average age of 4.6 ± 2.6 years. The primary surgical procedures included chalazion incision and curettage (62.89%), strabismus surgery (18.98%), trichiasis surgery (14.36%), eyelid or orbital mass resection (2.49%), blepharoptosis surgery (0.91%), and other procedures (0.37%). The average operative time was 25.28 ± 20.45 minutes (n = 2,698), while the average length of hospital stay was 8.45 ± 2.61 hours. No serious adverse events or death happened. One case had delayed postoperative hemorrhage, one had a postoperative infection, and two had delayed discharge. The rate of unplanned reoperation was 0.39% 90 days after surgery, with recurrence of chalazion and postoperative complications of ptosis as the primary reasons. ConclusionsPediatric ophthalmic ambulatory surgery under general anesthesia is a feasible and efficient operation mode with few complications for simple procedures with good general conditions. Further randomized controlled studies are needed to provide strong evidence of the safety and socioeconomic efficacy of this mode.

Neuro-Ophthalmic Manifestations of Carotid Cavernous Fistulas: A Systematic Review and Meta-Analysis.

Carotid-cavernous fistulas (CCFs) are pathologic, arteriovenous communications between the carotid artery and cavernous sinus. They cause various complex neuro-ophthalmic symptoms by shunting the flow of arterial blood into the venous system. In this study, a systematic review is conducted on the neuro-ophthalmic presentations associated with CCFs. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses2020 guidelines were followed during the systematic review. We searched PubMed, Scopus, and Web of Science from inception to December 31, 2023. Articles written in English on patients with confirmed CCFs reporting clinical features, diagnostic modalities, treatment approaches, and outcomes were included. Abstracted data included demography, clinical presentations, venous flow dynamics, trauma history, investigative methodology, approaches to treatment, and outcomes. Overall, 33 studies with a total number of 403 patients were included. The mean age at presentation was 42.99 years for patients with direct CCFs and 55.88 years for those with indirect CCFs. Preponderance was observed in male patients with direct CCFs, constituting 51.56%, while females predominated in those with indirect CCFs, at 56.44%. The clinical symptoms in all patients with CCFs were proptosis in 58 cases (14.39%), conjunctival congestion in 29 patients (7.20%), diplopia in nine patients (2.23%), vision blurring in four patients (0.99%), eyelid swelling in five patients (1.24%), pain in the eye in three patients (0.74%), and an upper lid mass in one patient (0.25%). Endovascular treatments, including coil and Onyx embolization, have been effective in relieving clinical symptoms and arresting the progression of these symptoms. In conclusion, the common clinical features in CCFs usually underline proptosis, congestion, and diplopia, necessitating a comprehensiveneuro-ophthalmological review. Prompt identification of the symptoms of blurred vision is crucial to avoid permanent damage. Lid swelling, ocular pain, and an upper lid mass are less common but equally essential presentations for comprehensive evaluation. The recognition of these variable presentations is essential not only for timely intervention but also for the improvement in patient outcomes, thus emphasizing the role of clinician awareness in managing CCF cases.

Clinical analysis of 37 Chinese patients with ocular amyloidosis: a single center study

ObjectiveTo examine the clinical characteristics, diagnosis and treatment, and prognosis of ocular amyloidosis in a Chinese population.MethodsA retrospective case series study was conducted. The clinical data of 37 patients with ocular amyloidosis were collected and the clinical characteristics, diagnosis and treatment, and prognosis were summarized and analyzed.ResultsThe 37 patients included 12 males and 25 females ranging in age from 22 to 75 years, with median age of 49 years. The clinical signs and symptoms included a conjunctival mass in 37 patients (100%), periorbital discomfort or pain in 29 patients (61.9%), ptosis in 18 patients (23.8%), exophthalmos or eyeball displacement in 3 patients (14.3%), restricted eye movement in 2 patients (9.52%), vision loss in 1 patient (4.76%), and diplopia in 1 patient (4.76%). A total of 29 patients had only conjunctival involvement and 8 patients had concomitant orbital and conjunctival involvement. The main treatment for patients with conjunctival involvement was surgical resection. Thirty-one patients had stable disease, 4 patients progressed or relapsed, and 2 patients were lost to follow-up.ConclusionOcular amyloidosis most commonly presents as an eyelid or conjunctival mass or diffuse thickening and can also present as an orbital mass. Diagnosis is mainly dependent on histopathological examination. Surgery is the main treatment and is done to confirm the diagnosis to guide further treatment, preserve function, and prevent complications that threaten visual acuity. Close postoperative follow-up is necessary.

Peripheral giant cell granuloma of orbit: A case report

Giant cell reparative granuloma (GCRG) is a rare locally aggressive benign lesion of orbit with a total of less than 15 reported cases worldwide. A 35-year-old male presented with a left upper eyelid mass. Contrast-enhanced computed tomography orbit revealed a soft-tissue density lesion of the extraconal compartment of the left orbit. Wide local excision was done. Histopathology showed peripheral giant cell granuloma of the orbit with fibroosseous component. No recurrence has been seen after eight months. Definite diagnosis of GCRG is only possible by excision biopsy. Early intervention is important to differentiate from malignant lesion.

Intraepithelial Sebaceous Gland Carcinoma: A Multicenter Retrospective Case Series.

Intraepithelial sebaceous gland carcinoma is a rare form of sebaceous gland carcinoma, with 10 published case reports to date. The authors report the clinical, histological, and prognostic features of this rare carcinoma. This is a multicenter retrospective case series of patients from 3 Australian sites. Information collected included patient demographics, clinical risk factors, initial and subsequent presentations, histology results, management, and outcomes. Twelve cases were identified. The average age of presentation was 72 years (range 52-92 years), with more females (n = 8) affected than males. The most common symptoms and signs were ocular irritation (n = 9) and eyelid mass (n = 8), with a predilection toward upper lid involvement. Five cases of sebaceous gland carcinoma were confirmed on initial histology. Initial management included wide local excision with margin control (n = 11), and primary topical mitomycin C (n = 1). Adjunctive conjunctival mapping biopsy was performed in 5 cases. Recurrence occurred in 7 cases, at an average of 31 months (range 7-83 months) after initial treatment. There were no cases of distant metastasis, however, 2 cases developed local invasion. Management of recurrences included exenteration (n = 2), further excisions alone (n = 3), and excision with adjuvant mitomycin C (n = 2). Clinicians and pathologists should have a high index of suspicion for primary intraepithelial sebaceous gland carcinoma on the upper eyelid. Close follow-up is recommended, given the high risk of local recurrence.

A rare case of eyelid choriostoma in an adult male: A case report

Choristomas are rare tumors, commonly occurring in the head and neck region. These are defined as the presence of normal tissues, such as muscle, bone, cartilage, dermal appendages, and epidermal components, in abnormal locations. They are mostly seen in the pediatric population. Occurrence in the adult population is fairly rare. Ocular choristomas comprise a substantial portion of all conjunctival and corneal tumors. These are the most common types of epibulbar and orbital tumors in children. Rarely, they may present as a growth in the eyelid region. The authors present one such rare case of eyelid choristoma masquerading as a chalazion, in an elderly patient. The patient presented with an eyelid mass, initially diagnosed as a Chalazion. The mass was excised and sent for histopathological evaluation, which revealed fibrocartilagenous tissue, suggesting a choristoma. The patient was followed up for a period of six months, without any recurrence.

Cellular neurothekeoma of the eyelid: A rare tumor with a common clinical presentation

We report a case of cellular neurothekeoma (NTK) in a 4-year-old male boy, which presented as a painless, progressive, left upper lid mass of 6 months’ duration. The left upper lid mass was solitary and dome shaped, causing mechanical ptosis. A magnetic resonance imaging (MRI) was performed followed by surgical excision of the mass in two stages, which, after histopathology and immunohistochemistry, was confirmed to be cellular NTK with no recurrence reported so far. To our knowledge, cellular NTK (a variant of NTK), an uncommon benign skin neoplasm involving the ocular adnexa (eyelid), is extremely rare. It is important to differentiate it from other malignant lesions, so that aggressive treatment can be avoided. The treatment of choice in cellular NTK is complete excision with clear margins.

Chondroid Syringoma of the Upper Eyelid in an Elderly Female

Chondroid syringoma is a rare benign mixed skin tumour. Though head and neck region is commonly involved, we report a rare case of a 55-year-old female who presented with a slow growing, painless swelling over the left upper eyelid and history of surgical excision of 2 such swellings in the arm 3 years back. FNAC and excision biopsy revealed Chondroid syringoma. Considering the chances of malignant transformation and recurrence, chondroid syringoma should always be a differential diagnosis in eyelid masses and total excision with long term follow-up should be done.

Sebaceous carcinoma in a 54-year-old Black African man after cancer chemotherapy: a case report

BackgroundSebaceous carcinoma is a very rare malignant skin adnexal tumor that is occasionally aggressive. We have not seen a case of sebaceous carcinoma in our center in the last 10 years. It is extremely rare in Black Africans.Case presentationWe described the case of a 55-year-old man African man who presented to our ophthalmologist with complaints of growth on the right upper eyelid for 8 months. He had surgery and chemotherapy for rectal carcinoma 6 years prior to presentation and received his last dose of chemotherapy 5 years before seeing our ophthalmologist. There was a history of spontaneous unprovoked bleeding from the lesion. He subsequently underwent surgical excision under general anesthesia. Histology of the mass showed an effaced architecture due to proliferating malignant epithelial cells disposed as trabecules, solid nests, and tongues. The microscopic features of widespread multivacuolated cytoplasm of the neoplastic cells led us to conclude that the tumor was a sebaceous carcinoma. The patient is alive and well.ConclusionSebaceous carcinoma is a rare malignant skin adnexal tumor in Black Africans. It can present as an eyelid mass with spontaneous bleeding. It can follow cancer chemotherapy either because of its association with other tumors in Muir–Torre syndrome or because of mutagenic effects of chemotherapeutic agents.

Application of Intra-Orbital Septal Transfer of Lateral Orbital Septal Pedicled Fat Flap in the Treatment of Upper Eyelid Dents

Objective: To observe the clinical effect of intraorbital septal transfer of the lateral upper eyelid mass and orbital septum pedicled fat flap in the treatment of upper eyelid depression. Method: During the double eyelid surgery, the fat mass on the lateral side of the upper eyelid was exposed, a small incision was made on the outside of the orbital septum, the fat in the orbital septum was released, the blood vessels on the inside of the root of the fat mass were preserved, and the fat was sharply separated from the outside to the inside. The mass is trimmed into a strip-shaped pedunculated fat flap. A small lateral incision is made along the lateral side to separate the medial fat mass in the orbital septum. The separated fat flap is refilled into the orbital septum from the lateral incision and pulled to the medial side for fixation. Results: 33 patients were followed up for 3 to 12 months after surgery. Except for 1 patient with severe upper eyelid skin laxity who underwent surgical repair, the rest of the patients' upper eyelid depression was effectively relieved and the upper eyelids looked natural. The patients were satisfied with the surgical results. Conclusion: The intra-orbital septum transfer of the lateral upper eyelid mass and orbital septum pedicled fat flap is a simple and effective surgical method for the treatment of upper eyelid depression, with less pain and quick recovery. It is worth recommending in the treatment of upper eyelid depression.

Management of Post Tumor Resection in Inferolateral Eyelid using Periosteal Flap and Canthoplasty Technique – A Case Report

Introduction : Eyelid defect repair goals are providing supportive connecting tissue and functional mucosal epithelium. Posterior lamellar reconstruction for tumor resection defect is still challenging. In this case, lower eyelid reconstruction can be accomplished by elevation and rotation of periosteal flap as posterior lamella.
 Case Illustration : A 68-years-old male came with inferolateral eyelid mass of Left Eye (LE) that was increasing in last 3 months. On LE examination found solitary cystic cutaneous lesion in inferior palpebra near lateral canthal, sized7x5mm, fixated, regular, and chewy consistency. Anterior of mass has same color as adjacent skin with hyperpigmentation lesion and posterior side was translucent with telangiectasia. He was suspected with LE ductal dd epidermoid cyst.
 Discussion : Periosteal flap and canthoplasty is procedure to repair inferolateral eyelid defect that are large to be closed primarily, however it requires adequate lateral canthal skin and tarsal plate. Posterior lamellais restored to create connective tissue framework, proper contour, and vertical canthal height. Tumor was removed and preperiosteal plan inferior to inferior orbital rim was dissected. The anterior lamella then transposed superiorly to make sure it will cover posterior lamellar reconstruction. Periosteal flap from lateral canthal tendon of infraorbital margin was harvested, flap was crossed to form sharp canthal angle and sutured to tarsal edges of lower eyelids as posterior lamella. A week later, LE showed natural contour and good function without eyelid malposition.
 Conclusion : Periosteal flap as posterior lamella reconstruction of eyelid defects is effective and efficient to repair eyelid defect due to its simplicity, reliability, and low risk complication.

Chalazion-mimicked eyelid angiosarcoma in a young Asian with good prognosis: a case report

BackgroundAngiosarcoma is an extremely rare malignant tumor. So far, only about 42 cases of angiosarcoma involving the eyelids have been reported. Eyelid angiosarcoma occurs more frequently in elderly Caucasian males and is prone to misdiagnosis. We present a case report in a young Asian male patient with eyelid angiosarcoma that was misdiagnosed as a chalazion.Case presentationA 46-year-old South Korean male with no underlying disease had a right lower lid mass. The lesion was initially misdiagnosed as a chalazion at a local clinic, but a diagnosis of eyelid angiosarcoma was made after the first biopsy trial. PET-CT was performed to ensure that there was no metastasis in the whole body. Surgical excision with enough surgical margin was used alone for treatment and reconstruction was performed with a tarsoconjunctival advancement flap (modified Hughes procedure), which helped ensure good cosmesis. No recurrence was observed 4 years and 5 months after the surgery.ConclusionsThe current study presents the first case of chalazion-mimicked eyelid angiosarcoma in a young Asian male aged under 50 years. This case shows that even if a benign eyelid disease is suspected in a young patient, an incisional biopsy must be performed to confirm whether the lesion is malignant. Since the prognosis is good for the case of eyelid angiosarcoma, if there is no clear evidence of distal metastasis, surgical resection should be performed with an enough safety margin.

Pleomorphic adenoma of the upper eyelid: A rare clinical presentation and review of literature

A 26-year-old male presented with a cystic mass in the right upper eyelid of 3 years duration. The lesion was 1.0 cm × 1.0 cm in size with a smooth surface, nontender, and freely mobile under the skin. Complete surgical excision of the lesion was done under local anesthesia. The histopathological findings were suggestive of a pleomorphic adenoma (PA) of the right upper eyelid. PA of the eyelid is a rare tumor and needs to be considered in the differential diagnosis of eyelid mass lesions. Complete excision can help prevent future recurrences.

Preseptal upper eyelid lipoma: a case report

Lipomas are benign soft-tissue tumors that typically progress gradually. In this case report, we describe a 77-year-old woman who presented with a mass on the left upper eyelid. An ophthalmologic examination was normal, and ultrasonography revealed a 1-cm ill-defined mass in the subcutaneous fat layer of the left upper eyelid. The tumor was completely excised surgically, and a histopathological examination showed mature fibro-adipose tissue consistent with a lipoma. The patient had an excellent postoperative prognosis. Even though eyelid lipomas are extremely rare, it is important to carefully examine the integrity of the orbital muscle, orbital septum, and levator aponeurosis. Lipoma should be distinguished from herniated orbital fat or the lacrimal glands in the differential diagnosis of an upper eyelid mass.

A Case Report of Primary Eyelid Tuberculosis

Purpose: To report a rare case of primary eyelid tuberculosis treated using systemic anti-tuberculosis medications.Case summary: A 30-year-old male presented to our hospital with an upper eyelid mass in the left eye for 1 month. An atypical cystic mass, pale yellow in color with a smooth surface, was observed on the medial side of the left upper eyelid. There were no associated ophthalmic or systemic symptoms. Excisional biopsy of the mass was performed under local anesthesia and histopathological examination revealed chronic granulomatous inflammation with central Langhans-type giant cells. Acid-fast bacilli smear was negative, but polymerase chain reaction for <i>Mycobacterium tuberculosis</i> was positive. There were no significant findings in blood tests and chest radiographs. The patient was diagnosed with primary eyelid tuberculosis and treated with systemic anti-tuberculosis medications for 6 months. There were no complications or recurrences during 1 year of follow-up.Conclusions: Although eyelid tuberculosis is rare, early diagnosis through biopsy is important when a granulomatous tuberculosis lesion is suspected. Delayed diagnosis can lead to serious cosmetic and functional complications. Appropriate systemic anti-tuberculosis medications are required to treat these cases.

Accuracy in clinical diagnosis of benign peri-ocular mass lesions

To analyze accuracy in clinical diagnosis of peri-ocular benign lesions. A prospective, interventional study of 279 clinically diagnosed and or histo-pathologically confirmed eyelid mass lesions. At presentation, detailed demographic data, symptoms, duration since the mass noted, it’s location, size & physical appearance, progression/regression/recurrence of the lid mass if any and associated systemic ailments were noted. Then, a pre-treatment clinical diagnosis (PTCD) was made. The treatment given, its outcome and histo-pathological examination (HPE) report were noted. Results then analysed in terms of how many cases needed HPE and in how many did PTCD match with HPE reports. Commonest lesions were of infective type (64.5%) followed by cysts and neoplastic which together contributed for 26.9% cases and others like congenital, traumatic, depositive etc., contributed for 8.6%. Totally, 25.8% sent for HPE; 94.4% did match with PTCD. Accuracy in clinical diagnosis is good with a thorough understanding of physical characteristics of lid mass lesions. Studies on a large scale would be extremely beneficial for the practicing ophthalmologists and the training residents and also for public health-care planning.

Orbito-facial plexiform neurofibromatosis: a rare clinical image

An 18-year-old male reported chief complaints of inability to close his right eye. He is a known case of oro-facial plexiform neurofibromatosis for the past 12 years. The patient had undergone a debulking surgery in the right eyelid 2 days back. The patient´s left eye had been enucleated 10 years ago. On ocular examination, the right upper eyelid showed upper eyelid mass with 6 sutures post debulking on the upper eyelid with scleral show. The left eye had been enucleated and tarsorrhaphy sutures were present. The patient was managed with topical lubricating eye drops and gel as well as lid patching.