Lid Swelling: A Window to Diagnosis of Sarcoidosis

Sarcoidosis is a systemic inflammatory disease which commonly involves lungs, lymph nodes, skin and eyes. We have come across a 55 year male who presented with painless, progressively increasing swelling at medial aspect of right upper and lower eyelids since 8 months. There were no other ocular or systemic complaints. The patient was a known case of controlled diabetes mellitus. Swellings were soft, non-tender, non-fluctuant and not fixed to underlying structures. Overlying skin was normal, freely mobile. Rest ocular examination was normal. Excisional biopsy with clear margins was planned. Histopathological examination report showed sarcoidosis. On two year follow-up patient developed no other ocular, systemic or laboratory signs of systemic sarcoidosis. This case highlights that even isolated lid swellings can be a pointer to diagnosis of sarcoidosis and can be the only clinical presentation.