case_images: PMC3550313_01
case_images: (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.
case_images: kjo-27-52-g001.jpg
case_images: PMC3550313_01_kjo-27-52-g001.jpg
case_images: F1
case_images: 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).
case_images: 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).
case_images: kjo-27-52-g002.jpg
case_images: PMC3550313_01_kjo-27-52-g002.jpg
case_images: F2
case_images: A chest radiograph revealed an old tuberculous lesion without hilar lymphadenopathy (Fig. 2), and a Mycobacterium tuberculosis antigen-specific interferon gamma assay was negative.
case_images: (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).
case_images: kjo-27-52-g003.jpg
case_images: PMC3550313_01_kjo-27-52-g003.jpg
case_images: F3
case_images: 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).
case_images: (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.
case_images: kjo-27-52-g004.jpg
case_images: PMC3550313_01_kjo-27-52-g004.jpg
case_images: F4
case_images: 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).