Orange palpebral spots

We report 27 cases of adults (23 females/4 males, average age 53 years old) presenting yellow-orange pigmented symmetric spots in the internal part of their superior eyelids, different from xanthelasma. Most of them were not aware of their orange palpebral spots (OPS). A systematic observation of adults showed OPS on 15 out of 326 patients. Laboratory investigation carried out in 11 patients did not show particular results except a high level of vitamin E or of total carotenoids in single cases and of beta-cryptoxanthin in 5 cases attributed to the high consumption of citrus fruit during winter. In 9 out of the 10 biopsies performed, high-situated fat cells were observed in the reticular dermis, and Fontana pigments (+) in the superficial dermis and sometimes basal keratinocytes. In 1 case yellow-brown autofluorescent microgranular deposits that may correspond to lipofuscin were identified in the superficial dermis. The origin of OPS remains unclear; more than high-situated adipocytes colored by carotenoids, lipofuscin deposit could explain this color, easily visible due to the thinness of the skin in this part of the body. Identifying OPS avoids being mistaken about other pathologies, but further investigations are necessary to understand this entity better.