Gouty tophus on the eyelid.

A gouty tophus on the eyelid is a casuistic flash in the routine biopsy flow. There has been a 12th case reported in the literature, along with an analysis of the distribution by age, sex, location, size, and symptoms. Male gender predominates (10:2) within a wide age range (26-79 years), after a several-year history of gout, affecting mainly the canthi and, in only 4 cases, the middle area of the eyelids (the upper eyelid more often), with dimensions ranging from 4 to 14 mm. The tophi can be multiple (in 2 cases). In addition to aesthetic concerns and discomfort, the tophi caused mechanical ptosis of the eyelid on two occasions. A histologically confirmed eyelid tophus may serve as an early diagnostic stigma of the disease, even in the absence of hyperuricemia. Their occurrence may be either a manifestation of disseminated skin tophi or a localized disturbance of the protective alkaline homeostasis of the eyelid tissue.