Figure 1

Figure 2a

Figure 2b

Photos courtesy of: LV Prasad Eye Institute
Used with permission. Not to be reproduced.

A 56-year-old woman presented with complaints of an ulcerating lesion at the inner corner of right eye for the past 8 months [Fig 1]. There had been an off and on history of yellowish discharge from the lesion; occasionally it is blood tinged. She had a history of trauma with a wooden stick at the affected site, 10 months earlier. Clinically, a firm mass could be palpated. Extraocular movements were full. Slit lamp and fundus examination were within normal limits in both eyes. CT scan showing coronal [Fig 2a] and axial view [Fig 2b] is shown above.

1.	The most probable diagnosis is:
	a -- sebaceous gland carcinoma In canaliculitis, there is usually a history of chronic discharge of yellowish putty-like material from the pouting punctum and there is no ulceration of lid margin as in this patient. In dacryocystitis, there would be muco-purulent discharge (very less often blood tinged) from the punctum and the firm mass in this patient is not from lacrimal sac swelling. Basal cell carcinoma generally appears as a raised nodular lesion, with central ulceration and mainly affects (50%) the lower lid. The sebaceous gland carcinoma patient usually has a long history of a non-healing ulceration with yellowish discharge from the meibomian glands. Sebaceous gland carcinoma generally affects the upper lid and rarely involves the inner canthus as in this case. Lymph node examination is extremely important in any suspicious malignancies in the peri-ocular region. Note the tumor involvement on the CT scans.
2.	The treatment would be:
	d -- wide excision of the lesion with margin control The only treatment is wide excision of the lesion, while obtaining clear margins. Incomplete excision might increase the chances of recurrence or orbital invasion.