# Elongated, Pedunculated Verruca Vulgaris of Both Upper Eyelids: A Rare Bilateral Presentation

## TL;DR

An elderly woman had long, hanging warts on both upper eyelids that caused vision problems and required surgery to remove before cataract treatment.

## Contribution

This case highlights the rare bilateral progression of eyelid warts leading to visual impairment and the need for timely intervention.

## Key findings

- Bilateral pedunculated eyelid warts can grow large enough to obstruct vision over time.
- Surgical removal of the warts was necessary before cataract surgery to restore vision.
- Postoperative monitoring is essential due to the association with low-risk HPV.

## Abstract

A 71-year-old woman presented with progressive visual decline due to bilateral upper eyelid masses and bilateral cataracts that obstructed her visual axis. The lesions had gradually elongated over approximately ten years after a dermatologist deemed surgical removal impossible. Excision of the pedunculated tumors was performed prior to cataract surgery because the lesions drooped over the visual axis and would have obstructed the operative field. Subsequent cataract surgery restored visual acuity to 20/20 in the right eye and 20/25 in the left. This case illustrates that verruca vulgaris of the eyelid, though benign, can elongate into large pedunculated masses if neglected, potentially leading to functional visual impairment. As this condition is associated with infection by low-risk human papillomavirus (HPV) types, careful postoperative monitoring for recurrence is required.