A Case of Periocular Hyperpigmentation Suggestive of Argyria

Purpose: Here, we report a case of periocular hyperpigmentation suggestive of argyria in a 40-year-old woman and discuss its differential diagnoses. Case summary: A 40-year-old woman presented with persistent bluish discoloration around the eyes, which initially involved the entire face following sleep disturbances two months previously. Her medical history included hormone replacement therapy (Progynova and Provera), facial picotoning laser treatments, and herbal medicine intake. The patient had no history of ophthalmic or systemic diseases or direct exposure to heavy metals or toxic substances. Slit-lamp examination revealed no silver deposition in the cornea or conjunctiva. Blood tests, urinalysis, and hair heavy metal analysis revealed no abnormalities. The patient declined skin biopsy, which was recommended via dermatology consultation. After a two-month follow-up period, the discoloration partially improved, but the upper and lower eyelids remained pigmented. Conclusions: Despite normal findings in blood and heavy metal tests, argyria was considered based on the clinical presentation. However, histopathological confirmation was not obtained, and hormone therapy-associated melasma, post-laser hyperpigmentation, and periorbital melanosis were considered as differential diagnoses. This case highlights the importance of a systematic differential diagnostic approach to periocular hyperpigmentation.