An unusual orbital tumor in an adult: Granuloma annulare
Granuloma annulare (GA) is a rare clinical entity that does not classically arise from the peri-orbital area in adults. The present article appears in the American Journal of Ophthalmology Case Reports that describes a case of a 69-year-old female with GA of the orbit. Furthermore, the pathological and immunohistochemical features of these tumors are discussed.

A 69-year-old female who first presented to the ophthalmology service due to symptoms consistent with chronic scleritis, epiphora and left upper eyelid ptosis. The patient was treated with oral NSAIDS with resolution of the scleritis symptoms. She was referred for oculoplastic evaluation of the epiphora and ptosis.

After evaluation by the oculoplastic service, the left-sided ptosis and nasal lacrimal duct obstruction were confirmed. Subsequently, a left levator resection was planned. Once healed, the patient underwent a left dacryocystorhinostomy (DCR). Approximately one month after DCR surgery, the patient presented to the clinic due to a focal area of induration, mild erythema and minimal sensitivity to palpation below the left lower lid. She was treated for focal post-operative cellulitis. Upon completion of the antibiotic course, the firm area below the left eye was still present. Due to concern for resistance, another antibiotic was prescribed for a ten-day course, with symptomatic improvement.

Three months later, the painless mass along the inferior orbital rim persisted, though had not significantly enlarged. The decision was taken to undergo biopsy for histopathological correlation. Intra-operative frozen sections confirmed the presence of granulomatous inflammation. Due to the absence of hematologic abnormalities, including absence of paraproteinemia, the decision was made to treat the lesion locally with topical steroid cream.

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