Mrs. Rahima Begum, an 80-year-old female from Dhaka, presented with a rapidly growing, ulcerated lesion on her left upper eyelid, eventually diagnosed as sebaceous gland carcinoma, alongside age-related cataract in her right eye. She has been managing diabetes and hypertension without prior medical intervention for her eyelid growth. A plan for management includes biopsy, chemotherapy, and cataract extraction.

1. DR.MALIHA NAWAR
Resident, Phase-B
Community
Ophthalmology
Bangabandhu Sheikh
Mujib Medical
University
CASE
PRSENTATION

2. Particulars of the patient:
Name- Rahima Begum
Age- 80 years
Sex- female
Religion- Islam
 Occupation- Housewife
Address- Khilgoan,Dhaka.
Date of examination- 04/06/2024

3. Case Summary:
Mrs. Rahima Begum,80 years old female residing in
khilgoan,Dhaka came to BSMMU Community Ophthalmology OPD
with complaints of growth over left upper eyelid for 1.5 years. She
was reasonably well 1.5 years back then she developed a small
nodule on left upper eyelid which was painless and slowly growing
in nature. She gave history of taking homeopathy for the growth in
hope of cure, instead of visiting doctors.

4. But in last 5 months the growth increased rapidly. She also
complaint of loss of appetite for same duration. Now she has
come to BSMMU for better management. She is diabetic and
hypertensive. She has no history of ocular trauma or surgery. None
of her family members have such type of illness.

5. General Examination:
Appearance- ill – looking
Pulse- 68b/min
Blood pressure 90/60mmHg
Temp. 98F
Lymph node- Not palpable
Other vital parameters are within normal limit

6. Local Examination:
Inspection:
Facial asymmetry present
Growth involves left upper eyelid,
medial and lateral canthus.
Shape: Irregular

7. Surface: ulcerated lesion with oozing margin
Palpation:
Size: (30⨉12⨉2)mm
Base :Fixed with underlying structure
Margin: Irregular
Mobility: Non-mobile

10. Ocular Examination:
R/E L/E
Visual acuity: (unaided)
Distant
Near
Pinhole
HM
N12
6/60
NPL
BCVA 6/36,+1.50Ds*+1.00Dcyl@
90˚
N8, +2.50D sph
Could
Not
Pupillary Light Reflex Brisk Be
Ocular motility Full in all gazes Evaluated
Color vision Trichromatic

11. Slit Lamp Examination:
OD OS
Eyelid and eyelashes Normal Growth involves left upper eyelid,
medial and lateral
canthus(30 12 2)mm, Eyelash
⨉ ⨉
absent
Conjunctiva Not congested Could not be assed
Cornea Transparent Growth involves 6 to 12 o’clock
position
Anterior chamber Normal in depth both centrally and
peripherally.
Could
Iris Normal in color and pattern Not
Pupil Round, regular and reacting Be
Lens Nuclear sclerosis grade
IV+cortical+PSC
Evaluated
IOP(GAT on 04/16/2024@ 11.10am)
mmHg
13

12. Fundoscopic examination:
OD OS
Media Clear
Optic disc C:D= 0.3:1
Pink
Margin well defined.
Could
Blood vessel Number of blood vessels
normal.
Not
Be
NRR Healthy Evaluated
Background fundus Tessellated,RPE atrophy
present
Macula Healthy

13. Color Fundus
Photography
(OD)

14. Provisional Diagnosis:
Sebaceous gland carcinoma of left upper eyelid with age related
cataract in right eye.

15. Differential Diagnosis:
Squamous cell carcinoma.

16. Investigations:
CBC with ESR.
RBS
Blood grouping and Rh typing
Serum creatinine
SGPT
Urine R/E
ECG
ECHO
HbsAg
Anti-HCV
CT scan of orbit with contrast

19. Plan of management:
1. Proper counselling of the patient
2. Incisional biopsy to confirm diagnosis( Done on 06/06/2024)
Chemo therapy (to reduce size) L/E
Exenteration
3. Cataract extraction with PCIOL in R/E

21. Post Operative

43. Thank You