PMC3550313_01
(A) Photograph of a 70-year-old female with diffuse swelling of the left lower eyelid. Computed tomographic scans, (B) axial and (C) coronal, showed no evidence of a mass lesion or soft tissue infiltration.
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F1
A 70-year-old female presented with a history of painless swelling of the left lower eyelid for one year (Fig. 1A). A computerized tomography (CT) scan of the orbit was unremarkable (Fig. 1B and 1C).
Chest radiograph shows multiple confluent irregular opacities (arrow) in right upper lobe. There are no remarkable findings in hilar region with shadow of aortic arch (arrowhead).
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F2
A chest radiograph revealed an old tuberculous lesion without hilar lymphadenopathy (Fig. 2), and a Mycobacterium tuberculosis antigen-specific interferon gamma assay was negative.
(A) There are multifocal granulomas with lymphocytic infiltration in the fat (H&E, x40). (B) High magnification view shows a well-formed, non-caseating granuloma composed of epithelioid histiocytes with surrounding lymphocytes (H&E, x400).
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F3
The operative findings showed stiff and coarse orbital fat particles, and the histopathologic examination demonstrated non-caseating granulomas consisting of epitheloid histiocytes in the orbital fat, most likely caused by sarcoidosis (Fig. 3).
(A) The patient showed significant improvement of the left lower lid swelling after surgery. (B) Left lower lid swelling was completely resolved after low dose steroid treatment.
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F4
The patient was diagnosed with orbital sarcoidosis, and started on prednisolone (10 mg/day) in consideration of the significant improvement in eyelid swelling after surgical debulking (Fig. 4).