Recurrent bilateral periorbital swelling: JAMA case report
A 47-year old woman with a history of adult-onset asthma and waxing and waning bilateral swelling of the upper eyelids presented with greater swelling of the left than right upper eyelids with yellow lesions (Figure 1A). Previous episodes had been treated successfully with oral prednisone, and the patient had numerous recurrences within the past 10 years.

According to the patient’s report, a biopsy was performed several years ago at an outside institution, and the diagnosis was xanthelasma. She denied visual changes. Visual acuity was 20/40 OU and improved to 20/25 OU with pinhole testing. Intraocular pressures were normal, extraocular motility was full, and the pupils were round and reactive without an afferent pupillary defect.

Results of the examination revealed yellow lesions on both eyelids, palpebral swelling greater in the left than the right eye, erythema, ptosis, an S-shaped deformity of the left upper eyelid, and a palpable mass of the left superolateral orbit (Figure 1A). Hertel exophthalmometry showed 2 mm of relative proptosis in the left eye. Results of slitlamp and dilated fundus examinations were unremarkable.

A CT scan showed preseptal soft tissue swelling in both eyes and an extraconal left lacrimal gland mass extending behind the globe (Figure 1B). The patient started prednisone therapy with rapid improvement of symptoms. Biopsy with surgical debulking was performed in both eyes, and histopathologic evaluation revealed an inflammatory infiltration of foamy histiocytes and Touton giant cells consistent with xanthogranuloma (Figure 2).

The final diagnosis was adult-onset asthma and periocular xanthogranuloma.

Read more here: