Single-Stage Surgical Reconstruction in a Case of Rare Isolated Periorbital Cutaneous Sarcoidosis without Systemic or Orbital Involvement

Making an initial clinical diagnosis of sarcoidosis in an isolated periorbital swelling with mechanical obstruction of vision is challenging for a plastic surgeon and warrants a teamwork. Arriving at a definitive diagnosispost reconstruction, not in the list of common clinical differential diagnosis, brings a sense of surprise, fear of possibility of recurrence, and confusion regarding initial and further management. A 70-year-old hypertensive and hypothyroidmale onmedications presented with the left peri orbital region diffuse swelling involving, upper and lower eyelids with complete obstruction of vision since3years (►Fig. 1),Magnetic resonance imaging (MRI)with contrast revealed neurilemmoma with no intra orbital or cranial extension. He underwent debulking of excessive skin withunderlying soft tissue inaplaneabovetheorbicularisoculi muscles, themuscles appeared normal, primary closurewould result in significant tensionwith ectropion deformity; hence, a split-thickness skingraft for theupper eyelid and full-thickness skin graft for lower eyelid was planned and resurfaced (►Fig. 2). Postoperative period showed a good graft take and histopathology diagnosis showed sarcoidosis with non-caseating giant cell granulomas. Hewas later referred to immunology and was initiated on oral steroids. The patient was taught about upper eyelid closure exercises (►Figs. 3 and 4). Sarcoidosis, a chronic granulomatous disease of which, cutaneous sarcoidosis is typically categorized into isolated cutaneous