Nodular Colloid Milium of the Conjunctiva and Anterior Orbit

Colloid milium is a rare deposition disorder with accumulation of a characteristic amorphous substance in both protected and sun-exposed areas depending upon the disease subtype. The patient was a 59-year-old woman who was referred for evaluation of a gelatinous-appearing mass in the inferior fornix of the right eye, extending from the medial to the lateral canthal region, and extending up onto the bulbar conjunctival surface and anterior lacrimal gland. Hematoxylin and eosin stain of an incisional biopsy showed deposits of an amorphous brightly eosinophilic material within the conjunctiva with scattered plasma cells at the periphery. There was no evidence of monoclonality, and a Congo red stain was negative. Based on histopathologic findings, a diagnosis of nodular orbital colloid milium was made. To our knowledge, the adult and nodular forms of colloid milium have not been previously described as occurring in the conjunctiva or anterior orbit.