A 56-year-old female patient presented to our department in March 2008 with a history of chronic swelling of her left upper eye lid for the past 3 years that had become progressively worse over 2 months. There was associated skin redness but no discomfort or pain. The patient had consulted an ophthalmologist, who diagnosed chalazion and prescribed topical ofuloxacin ointment three times a day. The eyelid swelling, however, failed to regress despite 2 months of topical medication. The patient was subsequently referred to our department for further management.

Clinically, there was a soft tissue swelling over the medial aspect of her left upper eyelid, causing mild erythematous skin changes and 2 mm of mechanical ptosis (fig 1A). The marginal reflex distance of her lids measured right 3.5 mm and left 1.5 mm. Levator muscle function was normal in both eyes. Eversion of the left upper lid was not possible due to the size of the lid mass. On gentle lid distraction, a cystic lesion, bluish in coloration, was seen occupying the superior fornix (fig 1B). It was soft on palpation, non-mobile and did not cause any globe displacement. The left ocular motility was also unaffected. The patient had visual acuity of 20/20 in both eyes.