JAMA Ophthalmology Clinical Challenge
August 2015

Lower Eyelid Lesion

Author Affiliations
  • 1Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor
  • 2Department of Ophthalmology, University of Michigan, Ann Arbor
  • 3Department of Pathology, University of Michigan, Ann Arbor

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Ophthalmol. 2015;133(8):955-956. doi:10.1001/jamaophthalmol.2015.0711

An 11-month-old boy presented to the clinic with a papule on his right lower eyelid that had doubled in size since it first appeared 3 months earlier (Figure 1). He had been born at full term and was otherwise healthy. His medication regimen included a pediatric multivitamin. There was no history of trauma to the area. On examination, the patient’s pupils were equal in diameter and reactive to light, his ocular motility was full, and the lesion did not obstruct his vision. Findings from external examination were significant for a single 3 × 2 × 2–mm, red-brown, raised, solid, fixed papule at the center of the lower eyelid margin. There was no madarosis and no evidence of epiphora or conjunctivitis. The lesion was initially diagnosed as a hemangioma and the decision was made to monitor it. On examination 1 month later, the papule had grown slightly, with a 1 × 1–mm area of ulceration. It also appeared to encroach on the visual axis in the downgaze position. The parents reported that the patient had started to rub his eyelid intermittently, causing irritation and a minimal amount of associated bleeding.

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