Xanthelasma-like eyelid plaque secondary to periocular Demodex infestation with granulomatous dermatitis. Orbit 2026 Aug;45(4):536-538
Date
03/12/2026Pubmed ID
41818460DOI
10.1080/01676830.2026.2640962Scopus ID
2-s2.0-105032844995 (requires institutional sign-in at Scopus site)Abstract
Periocular Demodex infestation is common but exhibits a wide range of clinical presentations. We report a unique case expanding the clinical spectrum of periocular demodicosis. A 61-year-old Caucasian man with a history of multiple cutaneous malignancies presented with a 10 x 6 mm yellow plaque of the left upper pretarsal eyelid for one year associated with intermittent foreign body sensation. Examination demonstrated eyelid margin and lash line involvement with blepharitis, collarettes, and meibomian gland dysfunction. Biopsies of the lesion and eyelid margin were performed and revealed granulomatous dermatitis surrounding numerous Demodex mites. This case illustrates that periocular demodicosis may present as a xanthelasma-like eyelid plaque with granulomatous inflammation, mimicking xanthelasma, amyloidosis, or malignancy. Recognition of this atypical presentation is important, as biopsy of suspicious periocular lesions can establish the diagnosis and allow appropriate treatment.
Author List
Kates MM, Conto J, Wanat KA, Esmaili NAuthors
John Elliott Conto OD Professor in the Ophthalmology department at Medical College of WisconsinNeda Esmaili MD Associate Professor in the Ophthalmology department at Medical College of Wisconsin
Malcolm M. Kates MD Instructor in the Ophthalmology department at Medical College of Wisconsin
Karolyn A. Wanat MD Chair, Professor in the Dermatology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AnimalsBiopsy
Blepharitis
Dermatitis, Perioral
Diagnosis, Differential
Eye Infections, Parasitic
Eyelid Diseases
Granuloma
Humans
Male
Middle Aged
Mite Infestations
Mites
Xanthomatosis
