Differential Diagnosis for a 50-year-old with a Red Inflamed Bottom Eyelid and a White Spot on the Inner Eyelid

• Single most likely diagnosis:
  • Blepharitis: This condition is characterized by inflammation of the eyelids, which can cause redness, swelling, and a white or yellowish discharge. The white spot on the inner eyelid could be a meibomian gland cyst or a concretion, which is often seen in blepharitis.
• Other Likely diagnoses:
  • Chalazion: A small bump on the eyelid due to a blocked oil gland, which can cause inflammation and redness. The white spot could be the actual blockage or a sign of the underlying issue.
  • Hordeolum (Stye): An acute, localized infection or inflammation of the eyelid margin involving hair follicles of the eyelashes or meibomian glands. The white spot might represent the focal point of infection.
  • Eczema/Dermatitis: Allergic or irritant reactions can cause eyelid inflammation and might lead to the appearance of white spots due to scaling or other dermatitic changes.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Basal Cell Carcinoma: Although less common, a white spot on the eyelid could be a sign of basal cell carcinoma, especially if it's a new, growing lesion. Early detection is crucial for effective treatment.
  • Malignant Melanoma: Though rare, any new pigmented lesion, or a change in an existing mole on the eyelid, warrants investigation for melanoma due to its high mortality rate if left untreated.
• Rare diagnoses:
  • Sarcoidosis: This autoimmune disease can cause inflammation in various parts of the body, including the eyes. It might lead to uveitis or conjunctivitis, and less commonly, could cause eyelid lesions.
  • Angiosarcoma of the Eyelid: An extremely rare but aggressive malignancy that could present with eyelid swelling and redness. The white spot might be part of the tumor's appearance.