Giant eyelid eccrine hidrocystoma-induced progressive ptosis in childhood

Area of Science:

• Ophthalmology
• Pediatric Surgery
• Dermatology

Background:

• Upper eyelid tumors are uncommon in children.
• Eccrine hidrocystomas typically present as benign cystic lesions, usually on the face or eyelids.
• Progressive ptosis as the primary symptom of an eyelid hidrocystoma in early childhood is exceptionally rare.

Observation:

• A 9-year-old female presented with congenital, progressively worsening right upper eyelid ptosis.
• Clinical examination revealed right upper eyelid ptosis (marginal reflex distance of -1 mm) with preserved levator function (8 mm) and conjunctival cystic changes.
• Computed tomography (CT) imaging showed a well-defined, homogeneous cystic lesion without contrast enhancement.

Findings:

• Surgical excision of the conjunctival cyst was performed.
• A giant eccrine hidrocystoma, measuring 25 mm x 15 mm, was removed, representing the largest reported pediatric ocular case.
• Histopathological examination confirmed the diagnosis of eccrine hidrocystoma.

Implications:

• Giant eccrine hidrocystomas can manifest as progressive ptosis in pediatric patients.
• Prompt surgical intervention is necessary to address the ptosis and prevent the development of amblyopia.
• This case highlights the importance of considering rare orbital pathologies in the differential diagnosis of pediatric ptosis.