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JAMA Ophthalmology Clinical Challenge
June 2018

Rapidly Growing Eyelid Mass in an Elderly Man

Author Affiliations
  • 1University of Illinois at Chicago, Illinois Eye and Ear Infirmary
JAMA Ophthalmol. 2018;136(6):710-711. doi:10.1001/jamaophthalmol.2017.5480

A man in his 90s presented with a rapidly growing lesion on the left upper eyelid. The lesion appeared 2 months before presentation as a 1-cm red, painless nodule. He denied trauma or changes to his vision. His medical history was negative for malignant disease. He had a history of end-stage bilateral age-related macular degeneration. On examination, his visual acuity was hand motions OD and 20/200 OS. His intraocular pressures were normal, and extraocular motility was full. His pupils were equal and reactive to light without an afferent pupillary defect. The external examination revealed an exophytic mass on the left upper eyelid with areas of necrosis (Figure 1A). He had lymphadenopathy of the head and neck. Anterior segment examination showed conjunctival chemosis in the left eye, white and quiet conjunctiva and sclera in the right eye, bilateral clear corneas and deep and quiet anterior chambers, a dense cataract in the right eye, and a posterior chamber intraocular lens in the left eye. B scan of the right eye showed no masses or retinal detachment. His fundoscopic examination revealed a chronic hemiretinal vein occlusion.

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