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Updated: Feb 15, 2026

Pseudofracture: An Acute Peripheral Tissue Trauma Model
Published on: April 18, 2011
Enlarging Pigmented Eyelid Mass Associated with Remote Pencil Trauma
Paul O Phelps1, J Andrew Carlson2, Dale R Meyer2
1Ophthalmic Plastic Surgery, Lions Eye Institute, Slingerlands, New York, USA.
Abstract:
The authors present a case of a gradually enlarging pigmented mass of the upper eyelid and anterior orbit that was discovered to be the graphite tip of a pencil surrounded by macrophages bearing graphite and fibrous tissue. A 25-year-old woman with no medical history presented with a gradually enlarging pigmented lesion of her left upper eyelid. She denied any history of previous skin cancer, trauma, or previous surgery. A biopsy was performed. This revealed an encapsulated grayish, pigmented mass within the medial portion of the left upper eyelid and anterior orbit. Within the pigmented cocoon, the graphite core of a pencil ("pencil lead") was identified. Histopathology demonstrated granulomatous inflammation with fibrosis and macrophages.
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