A Rare Eyelid Condition: Congenital Coloboma

I recently saw a 25-year-old woman who was referred to me for evaluation of a persistent lesion on her right upper eyelid. Her primary doctor suspected it might be a large stye or sebaceous cyst.

But as soon as I examined her, I recognized something far more unusual: a congenital coloboma.

She explained that the lesion had been present for her entire life. It had never changed in size, never caused discomfort, and hadn’t interfered with her vision or eye function. She simply wanted to know what it was—and whether it needed to be removed.

On close inspection, the lesion involved the inner half of the eyelid margin. There were no eyelashes in the affected area, and the natural contour of the eyelid was irregular. Despite that, she had complete eyelid closure, no lagophthalmos (incomplete blinking), and no evidence of exposure or dryness on the surface of the eye.

When I gently palpated the bump, it felt soft and compressible—unlike most styes, which are usually firm and tender. There was no fluid inside. It was likely filled with soft fibrous or fatty tissue, a characteristic often seen in congenital lesions like this. It will likely remain stable throughout her life.

Colobomas are rare congenital defects that result when part of the eyelid fails to form completely during development. Some colobomas can be severe, involving large portions of the eyelid and requiring complex surgical reconstruction to protect the eye. In her case, the coloboma was relatively mild—and more importantly, not functionally significant.

She was reassured to know that no treatment was needed. While surgical correction is possible, it would involve full-thickness eyelid reconstruction with delicate flap work—not a decision to take lightly, especially when the lesion is stable and not causing problems.

This case is a great reminder that not all eyelid lesions are styes—and not all require treatment. Careful evaluation by an oculoplastic specialist can help avoid unnecessary interventions and provide peace of mind.