Primary cutaneous mucinous carcinoma of the eyelid is an adenocarcinoma of the eccrine glands. It is rare and locally aggressive but the prognosis following local excision, confirmed with tumour-free margins, is good. This tumour is usually described in the elderly. We present the occurrence, clinical and histological features, and management of this tumour in a young male.A 36-year-old male presented with a small cystic right lower lid lesion, which had increased in size and pigmentation over two years. He underwent excision biopsy for diagnostic purposes followed by Moh's micrographic surgical removal. The defect was repaired with an upper eyelid skin graft. A full oncological screen including whole-body computed tomography scan excluded the presence of primary mucinous carcinoma elsewhere and any metastatic spread. There has been no recurrence of tumour 18 months following excision. Ophthalmologists should be aware of the occurrence of this tumour in a younger age group than previously described. Moh's micrographic surgery is the most suitable method of treatment following exclusion of both distant primaries and metastases.

BACKGROUND AND PURPOSE: The Clinical Activity Score is widely used to grade activity of thyroid eye disease and guide treatment decisions, but as a subjective measurement and being confined to the anterior orbit, it has limitations. Non-EPI-DWI of the extraocular muscles may offer advantages as a functional imaging technique with reduced skull base artifacts, but the correlation with the Clinical Activity Score and patient outcome is unknown. Our aim was to establish the correlation between the Clinical Activity Score and non-EPI-DWI and to describe the additional value provided by adjunctive non-EPI-DWI in making clinical decisions. MATERIALS AND METHODS: This was a retrospective longitudinal study of 31 patients seen in a multidisciplinary thyroid eye disease clinic during 5 years who had at least 1 ophthalmic and endocrine assessment including the Clinical Activity Score and a non-EPI-DWI ADC calculation. The Spearman rank correlation coefficient was used to determine the relationship between the Clinical Activity Score and non-EPI-DWI. A patient flow chart was constructed to evaluate clinical decision-making, and receiver operating characteristics were generated. RESULTS: From 60 non-EPI-DWI scans, 368 extraocular muscles were selected for analysis. There was a significant positive correlation between the Clinical Activity Score and ADC (r s ¼ 0.403; 95% CI, 0.312-0.489; P , .001). ADC values were significantly higher in the Clinical Activity Score $ 3 group compared with the Clinical Activity Score , 3 group (P , .001). Our patient flow chart identified a third intermediate-severity cohort in which the non-EPI-DWI was particularly useful in guiding clinical decisions. CONCLUSIONS: The non-EPI-DWI correlated well with the Clinical Activity Score in our patients and was a useful adjunct to the Clinical Activity Score in making clinical decisions, especially in patients with intermediate activity and severity of thyroid eye disease.

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We report the first case of Sjögren's syndrome causing gross lacrimal gland swelling and secondary hypoglobus and uncharacteristically absent sicca syndrome. Histopathological diagnosis of the excision biopsy of the orbital lobe of the gland confirmed a mixed T and B cell infiltrate of the gland with no lymphomatous transformation. The condition remains quiescent following complete excision.

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