A gouty tophus on the eyelid is a casuistic flash in the routine biopsy flow. There has been a 12th case reported in the literature, along with an analysis of the distribution by age, sex, location, size, and symptoms. Male gender predominates (10:2) within a wide age range (26-79 years), after a several-year history of gout, affecting mainly the canthi and, in only 4 cases, the middle area of the eyelids (the upper eyelid more often), with dimensions ranging from 4 to 14 mm. The tophi can be multiple (in 2 cases). In addition to aesthetic concerns and discomfort, the tophi caused mechanical ptosis of the eyelid on two occasions. A histologically confirmed eyelid tophus may serve as an early diagnostic stigma of the disease, even in the absence of hyperuricemia. Their occurrence may be either a manifestation of disseminated skin tophi or a localized disturbance of the protective alkaline homeostasis of the eyelid tissue.

Drug delivery in cornea remains a challenge due to its unique dome shape, anatomy, epithelial barrier, rapid drug clearance, and eyelid blinking. Nanoscale-based drug delivery systems are particularly attractive for treating corneal diseases due to sustained local drug release without major side effects. Nano drug delivery systems have potential to overcome many limitations including drug's residence-time, controlled-release, and solubility in the cornea. This review provides an overview of critical considerations for corneal nanomedicine development ranging from the nanoscale-design to achieving an optimal drug delivery with a discussion on cornea-specific biology and diseases. Herein, we discuss key anatomical features and drug transport challenges across the tear film, mucins/glycocalyx, epithelium, stroma, and endothelium that can influence nanoparticle behavior. Further, article outlines indication-driven target drug profiling; core physicochemical parameters related to drug retention, penetration, distribution, and safety; and factors affecting sterility, osmolality, tolerability, and pH, regulatory expectations, and manufacturing reproducibility. Overall, nanoscale drug delivery systems offer an attractive approach to treat corneal dysfunction without major side effects.

Metastatic spread of invasive lobular carcinoma (ILC) to the eyelid is exceedingly rare and may masquerade as benign disease. We describe a woman in her 60s with a history of multifocal, estrogen receptor-positive ILC who presented with progressive, painless right periorbital swelling mimicking cellulitis. She was initially managed for presumed hordeolum and preseptal cellulitis without response over 4 months. Orbital MRI demonstrated non-specific preseptal thickening without a discrete mass. Given persistent symptoms, biopsy was pursued and revealed poorly differentiated carcinoma with immunohistochemical features consistent with breast origin. A repeat biopsy confirmed metastatic ILC with histiocytoid and signet ring cell morphology. This case highlights that orbital or eyelid metastasis from ILC can closely mimic inflammatory conditions and imaging may be non-diagnostic, delaying diagnosis. Clinicians should maintain suspicion for metastatic disease in patients with a history of breast cancer who develop unexplained orbital or eyelid changes to enable timely recognition and management.

The efficacy of cryosurgery for skin cancers is believed to depend on thaw time, which may be influenced by the presence of adrenaline in local anaesthetics due to its vasoconstrictive effects. This is the first study to perform detailed, non-invasive temperature measurements using infrared (IR) thermography during cryosurgery for basal cell carcinomas (BCCs), evaluating the impact of adrenaline on thaw time. A total of 15 patients with eyelid BCCs underwent cryosurgery with local anaesthetics both with and without adrenaline. Thawing was continuously monitored using a high-resolution IR camera and compared with the surgeon's visual assessment. No significant difference in thaw time was observed between anaesthetics with and without adrenaline. Thermographic mapping revealed a triphasic thawing curve. The surgeon's visual assessment of thawing corresponded well with the point at which tissue temperatures rose above 0°C, likely indicating the onset of reperfusion, thus providing a clinical margin beyond the actual phase transition. This is the first study to use IR thermography to monitor cryosurgery of BCCs, demonstrating that adrenaline in local anaesthetics does not affect thaw time. The findings suggest that deeper tissue perfusion during BCC treatment may counteract superficial vasoconstriction, supporting the effective use of cryosurgery regardless of adrenaline use.