Periocular pseudo-rheumatoid nodules commonly affect the orbital rim

To describe the typical presenting clinical characteristics and histopathology for periocular pseudo-rheumatoid nodules.

Clinical case-note and histopathological review for patients presenting to the Orbital Clinic at Moorfields Eye Hospital between 1994 and 2002.

Four females with biopsy-proven periocular pseudo-rheumatoid nodules presented between the ages of 22 and 33 years (mean 26.8 years), having a 4-month to 3-year history of newly formed (or recurrent) subcutaneous nodules-these overlying the superotemporal orbital rim and rarely tender. One patient had insulin-dependent diabetes for 22 years and one patient had bilateral disease. The masses were excised in all patients, with a minor recurrence in one, not requiring further treatment; one patient defaulted from follow-up.

Periocular pseudo-rheumatoid nodules appear to typically present in young females, possibly more commonly with type I diabetes mellitus, and form a rather characteristic slowly growing, firm, occasionally slightly tender, subdermal nodule overlying the superolateral rim of the orbit. Surgical excision improves the condition in many cases, although spontaneous regression might also occur.