A 94-year-old woman presented with chalazion and unilateral blepharitis of the left eye of 8 months' duration, having been treated topically with antibiotic ointment and eyelid washes.

Examination revealed erythematous swelling of the left upper eyelid, hard in consistency, mainly affecting the pretarsal area, with thickening of the affected area and madarosis of the area. Biomicroscopy showed an unaltered ocular surface, with no evidence of conjunctival or corneal involvement. There was ipsilateral preauricular adenopathy. An incisional biopsy of the lesion was performed and the pathologist reported it to be a sebaceous carcinoma palpebrae. The orbital computed tomography (CT) scan showed a large tumour of the left upper eyelid with infiltration of the preseptal fat, without infiltration of bone or retroorbital fat.

The patient was referred to oncology for further investigation. No distant metastases were found. Given the patient's age and the presence of lymph nodes, palliative radiotherapy was indicated. The local tumour diminished but radiotherapy proved intolerable for the patient and she stopped treatment. One year later the patient died of heart failure.