Eyelid Amyloidosis: A Rare Condition With Diagnostic Challenges

We present a rare and challenging case of a man who presented with mild mechanical ptosis and inferior dystopia, diagnosed with eyelid amyloidosis. A 40-year-old healthy man presented with a painless mass on his left upper eyelid that started one year ago. He noted that the mass increases in size when he eats meat, but there has been no overall progression over time. He experienced inferior dystopia with left upper eyelid fullness, swelling, and mild mechanical ptosis of the left eye. The measurements were as follows: marginal reflex distance 1 was 5 mm (oculus dexter, OD) and 4 mm (oculus sinister, OS); palpebral fissure height was 13 mm (OD) and 10 mm (OS); Hertel exophthalmometer reading at 105 was 22 mm (OD) and 23 mm (OS). CT was done with the impression of a dermoid cyst. It showed complex mass lesions of mixed fat, soft tissue, and calcification, predominantly involving the left upper eyelid with deeper extension into the superior compartment of the extraconal part of the fat of the orbit, close to the superior oblique levator muscle, with subsequent mild enlargement of the extraconal muscle group bilaterally, predominantly seen on the left side. The excisional biopsy showed amyloidosis. Amyloidosis is uncommon, progressive, and slowly associated with significant ocular morbidity. The diagnosis might be delayed because of an unusual presentation.