A 39-year-old woman presented to Wills Eye Hospital with a three-month history of swelling near the inner corner of her right eye. She reported severe pain over the right cheek, tearing and sinus congestion. She denied eye discharge, changes in visual acuity, numbness, diplopia, epistaxis, fever, chills or weight loss.


Medical History

The patient had no significant past medical history. She delivered a healthy child six months prior to presentation via cesarean section and was breastfeeding at the time of her initial visit. Her only medications were oral contraceptives. Family history was noncontributory. The patient denied alcohol, tobacco or illicit drug use, and had no known drug allergies. 




Visual acuity was 20/25 on the right and 20/20 on the left. Pupils were equal, round and reactive without afferent pupillary defect. Extraocular motility was full bilaterally. There was no globe dystopia or lagophthalmos. A 2.5 x 3.5 cm, tender, firm, raised mass with overlying skin hyperpigmentation was present inferior to the medial canthus on external examination of the right eye (Figure 1). There was no crepitus or fluctuance on palpation of the lesion. No mucous or bloody discharge was noted with lacrimal sac and mass massage. Facial sensation was intact bilaterally. Slit lamp and funduscopic examinations were normal bilaterally.

What is your diagnosis? What further workup would you pursue? Please click this link for diagnosis, workup, treatment and discussion.