Fat Infiltration in Eyelids: An Uncommon Clinical Case with Long-Term Monitoring

To describe a rare case of fatty tissue infiltration in the eyelids, leading to enophthalmos, and its successful surgical management with long-term follow-up.

We present the case of a 32-year-old woman with a three-year history of progressive, painless swelling of the right upper and lower eyelids. Clinical and radiologic evaluation included physical examination and magnetic resonance imaging (MRI). Histopathological analysis confirmed the diagnosis. Surgical resection was performed, and the patient was followed for over 24 months.

Examination revealed increased soft tissue volume in the right eyelids, narrowing of the palpebral fissure, and subtle hyperpigmentation. MRI showed fatty infiltration of the eyelids and reduced intraconal orbital fat, resulting in right-sided enophthalmos. No systemic, autoimmune, or infectious causes were identified. Histopathology confirmed fatty tissue infiltration and excluded neoplastic processes. Surgical excision of the abnormal tissue via upper and lower eyelid blepharoplasty was performed. At 14-month follow-up, the patient showed no signs of recurrence and was satisfied with the functional and cosmetic outcome, although enophthalmos persisted.

No instances of fatty tissue infiltration in the eyelid were discovered despite a thorough search for comparable cases in the literature. A few examples of lipomas affecting just one eyelid have been documented. But unlike a lipoma, this fat infiltration lacks fibrous septa and is poorly confined.

Fatty infiltration of the eyelids is an exceptionally rare presentation, especially when accompanied by intraconal fat loss and enophthalmos. This case highlights the importance of thorough imaging and histological analysis in atypical eyelid swelling. Surgical resection may offer a definitive and lasting solution. To our knowledge, this is the first reported case of its kind.