Eyelid abscess arising from an epidermal inclusion cyst

A 72-year-old woman presented with a 3-day history of focal pain and swelling of the left upper eyelid. A cystic lesion had been present in this area for longer than 7 years, and a lesion consistent with an epidermal inclusion cyst was present on the contralateral upper eyelid. An erythematous, tender, fluctuant mass was noted on the left upper eyelid consistent with abscess. It was drained and cultured, and the infection resolved with oral amoxicillin/clavulanate potassium followed by surgical excision. Histopathologic examination demonstrated an epidermal inclusion cyst and cultures grew anaerobic gram-positive cocci. Epidermal inclusion cysts are common eyelid lesions, yet infection is rare and may result from the spread of normal flora through the pore often found on the anterior surface of these lesions.