We report a case of recalcitrant bilateral upper eyelid cicatricial entropion associated with distichiasis/trichiasis which followed an adjuvant systemic chemotherapy. The chemotherapy, administered for treatment of breast cancer, consisted of docetaxel, carboplatin, and herceptin. Shortly following the combined chemotherapy treatment, epiphora and eyelash abnormalities commenced. The patient presented with a swollen eyelid margin and tarsal conjunctival inflammation associated with cicatricial entropion and diffused distichiasis/trichiasis affecting the upper lids, with greater severity observed in the medial portion. Despite manual epilation and multiple argon laser sessions, no improvement was noted. Surgical treatment was performed using a lid split, distichiasis excision of the right upper lid, and homolateral tarsoconjunctival graft. The biopsy examination showed chronic inflammation, dermal fibrosis with squamous metaplasia process, and an abnormal epithelial differentiation. After 6 months, entropion recurred. Tarsal marginal rotation associated with posterior lamella advancement was performed. However, cicatricial entropion and distichiasis/trichiasis recurred. The patient was prescribed bandage contact lenses and topical lubrication to relieve symptoms.

The purpose of this study was to report a series of cases of solitary fibrofolliculoma, a lesion seldom observed in the lids. Demographics, as well as clinical and histological aspects of the lesion were evaluated. Methods: This was a retrospective case series spanning a period of 18 years. All the included patients were diagnosed with solitary fibrofolliculoma confirmed by histological examination. Data regarding patient demographics, signs, and symptoms, course of the disease, location of the lesion, clinical and histological diagnosis, and outcome were collected. Results: Eleven cases of solitary fibrofolliculoma were diagnosed in the study period. The median age of patients was 51 ± 16.3 years (range: 27-78 years). Most patients were females (7/11; 64%). Five of the patients (45%) were asymptomatic; four (36%) reported bleeding, one (9%) had referred itching, and one (9%) rubbing of the lesion. The lesion occurred in a wide range of locations; one of them was located in the lids. The diagnosis for all lesions was histological based on characteristic findings of a hair follicle occasionally dilated and containing keratin material surrounded by a moderately well-circumscribed thick mantle of fibrous tissue. The infundibular follicular epithelium extended out into this fibrous mantle forming epithelial strands or cords. There were no relapses after exeresis. Conclusion: Solitary fibrofolliculoma is a rare lesion, seldom affecting the eyelids. We reported 11 cases, and the third case reported thus far in the literature affecting the lids. Diagnosis may be easily missed due to the nonspecific symptoms and clinical appearance.Therefore, it is necessary to perform excisional biopsy and histological examination for the recognition of this lesion.

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