Two brothers (both younger than 13 years) were evaluated for eyelid margin lesions (Figure). Lesions were present on all 4 lids in both boys. The lesions were itchy and did not respond to steroid or antibiotic therapy. Demodex test results were negative and tea tree oil was ineffective. A full-thickness eyelid biopsy showed dense deposits of eosinophilic hyaline material in the dermis. The lesions are examples of the moniliform blepharosis of lipoid proteinosis.
Belliveau MJ, Alkhotani A, Ali A. Moniliform Blepharosis of Lipoid Proteinosis. JAMA Ophthalmol. 2015;133(7):e150688. doi:10.1001/jamaophthalmol.2015.0688