Summary

We present a case of an 84-year-old man with advanced glaucoma on multiple unilateral glaucoma medication. He had 2 years history of unilateral ocular irritation thought to be related to his medication. Patient was referred to an oculoplastic clinic and found to have segmental eyelash loss partially masked by hypertrichosis caused by glaucoma medications. His symptoms were initially thought to be related to drop-induced blepharitis. A clinical diagnosis of possible basal cell carcinoma (BCC) was made and the incisional biopsy showed infiltrative micronodular BCC. The patient underwent Mohs micrographic surgery and eyelid reconstruction with a Hughes flap and full thickness skin graft. Timely diagnosis of BCC requires a high index of suspicion, particularly when the signs are subtle.