Man presents with rapidly growing eyelid lesion

A 52-year-old Latin-American man was referred to the Oculoplastics service at the New England Eye Center for evaluation of presumed pyogenic granuloma. The patient reported a history of a rapidly growing “stye” in his left lower eyelid for the prior 2 weeks. He denied any associated pain, erythema or discharge. Medical history was positive only for diet-controlled diabetes. He denied any history of malignancy or sexually transmitted infections such as HIV. Ocular history was unremarkable, including any history of trauma or surgery to the eyelid. He was not taking any medications. The patient also denied any history of smoking, intravenous drug use or high-risk sexual activity. He worked as a driver.Best corrected visual acuity was 20/25 in both eyes. The pupils were briskly reactive to light with no relative afferent pupillary defect in either eye, and IOP was 15 mm Hg in each eye. Extraocular muscle movements were fully intact, and confrontational visual fields were full in both eyes.