Periocular subcutaneous granuloma annulare in a child: A case report

PURPOSE: We describe a rare case of annular granuloma involving the eyelid of a child, a 6-year-old male, who presented with multiple subcutaneous nodular lesions involving the upper eyelid of the right eye. OBSERVATIONS: The slit-lamp examination of the eye was normal. Extra-ocular examination showed a lesion on the dorsal aspect of the right foot, which was resistant to treatment with topical corticosteroids. He underwent surgical excision of the eyelid nodules under general anesthesia. Histopathology with immunohistochemical staining of the excisional biopsy confirmed the diagnosis of annular granuloma, with positive Vimentin and CD68 stains in many palisading histiocytic cells, while Factor VIIIa, S100, and CD1a were negative. Tuberculosis was ruled out by negative Ziehl-Neelsen staining for acid-fast bacilli. CONCLUSIONS AND IMPORTANCE: This idiopathic granulomatous condition proved to be a benign, self-limiting cutaneous disease that can regress spontaneously. It affects the skin of the foot in more than 70% of all patients; however, involvement of the eyelid is extremely rare. We report this case to highlight such a rare entity and increase awareness regarding this dermatological condition among ophthalmologists.