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JAMA Ophthalmology Clinical Challenge
June 2016

An Atypical Ulcerated Lesion at the Eyelid Margin

Author Affiliations
  • 1Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
JAMA Ophthalmol. 2016;134(6):703-704. doi:10.1001/jamaophthalmol.2015.4965

An otherwise healthy adult man presented with left upper eyelid swelling for 2 days. This was accompanied by foreign-body sensation and discomfort of the left eye and was preceded by a week of general malaise without fevers or chills. He denied vision changes, light sensitivity, or drainage from the eye. He denied previous similar episodes of eyelid swelling or recurrent chalazia. He had no relevant medical history and his family history was negative for malignancy.

Clinical examination revealed an area of ulceration centrally along the left upper eyelid margin, measuring approximately 8 mm × 2 mm (Figure 1A). The eyelid demonstrated mild boggy edema; however, there were no associated nodules, vesicles, or plaques on the surrounding skin or face. There was mild madarosis in the area of ulceration. There was also a tender and enlarged preauricular lymph node on the ipsilateral side. The remainder of the clinical examination was unremarkable, including visual acuity, intraocular pressure, slitlamp biomicroscopy, and dilated fundus examination. A photomicrograph of a hematoxylin-eosin–stained section from an incisional biopsy specimen is shown in Figure 1B.

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