A Rare Case of Eyelid Rhinosporidiosis Masquerading as Eyelid Neoplasm

A 10-year-old girl presented with gradually increasing right lower eyelid mass for the past 10 months. On examination, there was a large, cystic, nontender mass over the right lower eyelid (Panel A). MRI showed a large preseptal mass which was hyperintense on T2-weighted sequences suggesting a lymphangioma (Panel B). The child underwent near-total debulking of the mass lesion by a subciliary incision. Intraoperatively, multiple yellowish dots were seen over the surface of a friable and vascular mass. Histopathology showed thick-walled sporangia containing numerous endospores in various stages of maturation in a background of fibrovascular stroma, suggesting rhinosporidial infection of the epidermis with granulomatous inflammation (Panel C). The patient did not have any recurrence at 2 years of follow-up (Panel D). Retrospectively, she gave a history of bathing in the ponds regularly. Rhinosporidiosis infection is endemic in the regions of India and Sri Lanka and is caused by the aquatic protozoan Rhinosporidium seeberi. Conjunctiva and lacrimal sac are the common sites to get involved. Eyelid involvement is quite rare. The treatment involves complete excision of the mass with cauterization of the surrounding tissue and the bed. Oral dapsone has also been used in recalcitrant cases.