We describe a 4-year-old boy who presented with progressive right periorbital edema and proptosis, with no systemic symptoms, who was found to have B-lymphoblastic leukemia (B-ALL). Magnetic resonance imaging (MRI) showed an enhancing mass centered in the right superolateral extraconal orbit. Orbital biopsy was consistent with B-ALL (CD99, TdT, LCA cocktail, CD34, CD79, CD10, PAX5, MIB1 positive; CD3, CD20 negative). A subsequent bone marrow aspirate confirmed a diagnosis of B-ALL with 80% blasts by flow cytometry and haploid cytogenetic findings. The patient improved clinically after chemotherapy. There are seven cases previously reported in the literature with hematogenous orbital masses at initial presentation of childhood ALL, but all with systemic symptoms or an abnormal complete blood count (CBC) at presentation. Our case is the first report in which an orbital mass preceded detectable systemic or laboratory evidence of ALL. This patient highlights the importance of differentiating benign causes of eyelid swelling from malignant ones.

Background: Understanding how periocular nonmelanoma skin cancer (NMSC) impacts quality of life (QoL) provides insight into the patient experience. Objective: To prospectively measure QoL of individuals with surgically treated periocular NMSC. Methods: Responses to the skin cancer index (SCI) and FACE-Q questionnaires were obtained at preoperative (PRE), postoperative week 1 (POW1), and postoperative month 3 (POM3) visits. Statistical analysis was performed using paired t -test and stepwise linear regression. Results: Forty-five patients participated in the study. Improved QoL as reflected in an increased mean difference of the total SCI score at PRE and POM3 visits (25.8, 95% confidence interval [CI 20.0 to 31.6]) and FACE-Q early life impact of treatment score at POW1 and POM3 visits (19.0, 95% CI [14.9 to 23.0), and a decreased mean difference of the FACE-Q adverse effects score at POW1 and POM3 visits (−1.3, 95% CI [−2.4 to −0.1]) was observed. Linear regression of the SCI and FACE-Q scores using demographic and clinical attributes revealed several predictors of postoperative QoL. Conclusions: Surgical management of periocular NMSC results in improved QoL, demonstrated at the final postoperative visit.

A healthy, asymptomatic woman was referred after incidental discovery of a right superior incongruous hemianopia. Magnetic resonance imaging disclosed a schizencephalic cleft passing through Meyer’s loop of the left optic radiation. The lesion may have resulted from a focal vascular accident or disruption of cortical neurogenesis during gestation.

To report a rare case of endocrine mucin-producing sweat gland carcinoma (EMPSGC) of the eyelid, initially misdiagnosed as a chalazion. A 76-year-old South-Asian male presented with a 9-month history of a painless left upper eyelid lesion. Initial ophthalmic assessment suggested presence of a chalazion that did not resolve with medical management. Examination revealed a 5.5 × 5.5 mm mass at the central left eyelid margin. The lesion transilluminated and extended over the eyelid margin, with splayed lashes but no madarosis. Histopathological examination demonstrated cribriforming glandular epithelium with extracellular mucin and synaptophysin expression, confirming EMPSGC with associated mucinous carcinoma. The patient underwent successful Mohs micrographic surgery with oculoplastic reconstruction and with no evidence of recurrence at five-month follow-up. EMPSGC is an uncommon, low-grade adnexal neoplasm, often under-recognized due to its benign appearance. This case highlights the importance of considering EMPSGC in the differential diagnosis of persistent eyelid lesions, particularly those unresponsive to conservative treatment. Histopathologic evaluation is critical for early recognition and appropriate management of lesions.