Persistent Upper Eyelid Lesion in Young Adult Male

Case at a Glance

A 25-year-old Filipino male presents with a slowly enlarging, non-inflammatory nodule on the upper eyelid that has been present for 2-3 years.

Patient's Story

The patient first noticed a small bump on his upper eyelid approximately 2-3 years ago. He describes it as a non-painful, firm lesion that did not respond to attempted drainage or manipulation. Recently, he observed that the lesion had increased slightly in size, prompting him to seek medical evaluation. The patient reports no associated symptoms such as pain, discharge, or visual disturbances. Family members had not expressed significant concern about the appearance of the lesion.

Initial Assessment

Physical examination revealed a small, well-circumscribed, flesh-colored nodule located on the upper eyelid. The lesion appeared smooth, firm to palpation, and measured approximately 2-3mm in diameter. There were no signs of inflammation, tenderness, or surrounding erythema. The patient's visual acuity and eye movements were normal.

The Diagnostic Journey

Given the clinical presentation of a persistent, asymptomatic eyelid nodule in a young adult, differential diagnoses considered included milium, epidermoid cyst, sebaceous cyst, or benign eyelid tumor. The chronic nature, lack of inflammatory signs, and characteristic appearance suggested a benign etiology.

Final Diagnosis

Milium - a benign keratin-filled cyst commonly occurring on the eyelids

Treatment Plan

Patient counseling regarding the benign nature of the condition. Treatment options discussed included: 1) Conservative management with observation, 2) Surgical excision if cosmetically bothersome or if further enlargement occurs. Given the small size and lack of functional impairment, initial conservative management was recommended.

Outcome and Follow-up

The patient was educated about the benign nature of milia and informed that these lesions can persist from days to decades without intervention. Surgical removal was presented as an option if the lesion becomes cosmetically concerning or continues to enlarge. Follow-up was scheduled as needed based on patient preference and any changes in the lesion's characteristics.