Atlas of Ophthalmology

Sarcoidosis presenting as a solitary subcutaneous eyelid mass

Lids -> Tumors, Neoplasma -> Benign Tumors
46 year old lady presented to the ophthalmology department with 6 weeks duration of insidious onset of left upper lid lump associated with mild pain and tenderness. The patient was otherwise healthy with no other systemic symptoms and signs. This lesion was treated initially by the general practitioner with Erythromycin tablet 250 mg four times a day with no improvement. Examination reveals a 30x8 mm mass in the left upper lid above the tarsal plate, mobile, non tender associated mild erythema (Figure 1&2). LogMar visual acuity was 0.1 in the right eye and 0.3 in the left. The vision was stable and the left eye is the weakest due to amblyopia. There was no clinical lacrimal gland involvement. Anterior and posterior segment examinations were unremarkable with normal intraocular pressures. Blood tests were arranged including full blood count, U&E, liver function test and Calcium profile, ACE, ESR, CRP and RF. The results of ESR and CRP were high (41 mm/hour and 42 mg/L respectively). ACE was 83 micrograms/L. The rest of the tests showed values within the normal range. Excisional biopsy was performed to remove the whole lesion under local anaesthesia. The histopathological report returned with the following information: florid non caseating granulomatous infiltrates with numerous multinucleate giant cells (Figure 3) highly suggestive of Sarcoid lesion. No neutrophiles or plasma cells were found in the specimen. The patient was referred to the chest physician for further evaluation and management. No pulmonary involvement was detected clinically and radiologically. The team finally decided to treat the patient with a systemic course of steroids. The patient was reviewed regularly over the next 12 months with no further manifestations.

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