A 49-year-old man with unilateral, nontender left eyelid swelling

A 49-year-old Hispanic man presented to the Los Angeles County Hospital Ophthalmology clinic with a nontender, left upper eyelid swelling of 14 months’ duration (Figure 1). On two occasions, his eyelid had been lanced at an outside ophthalmology clinic and yielded a “dark, reddish-brown liquid,” which did not grow any organisms on bacterial culture. According to the patient, the edema improved for 3 days after lancing and then recurred. A 3-week course of oral phenylephrine hydrochloride 20 mg/chlorpheniramine maleate 4 mg and a 4-week trial of sulfamethoxazole/trimethoprim double strength 500 mg twice daily prescribed by the patient’s referring doctor had no effect. The apparent cellulitis, which had slowly worsened over a month then stabilized in character for more than a year, led to the patient’s loss of employment and further rendered him unable to obtain work in the food industry due to concerns over his appearance. The patient denied any eye pain or changes in his vision, including loss of vision or diplopia. He had no other systemic symptoms and denied any facial muscle weakness. Past medical and surgical history were unremarkable. Other than the 2 previous eyelid lancings, the patient denied any other eyelid surgery, injectables, or ocular history. The patient was not on any medications. Family and social history were noncontributory.