Missed feeder vessel induced recurrent and refractory arteriovenous vascular malformation in the upper eye lid

A 25-year-old male presented with recurrent swelling in the left upper eyelid despite multiple surgeries in the past 6 years. He was initially misdiagnosed as capillary hemangioma elsewhere, for which multiple surgical excision procedures were done. In 2020, he presented to us for a second opinion regarding the same painless swelling which recurred at the same site. Clinical examination and Doppler ultrasound shifted the diagnosis in favor of arteriovenous malformation (AVM). Computed tomography of the brain and cerebral angiogram (three-dimensional reconstructed) images confirmed the AVM in the left upper eyelid with an arterial feeder from the left ophthalmic artery branch. The patient had multiple recurrences due to the inadvertent misdiagnosis and missed management of the feeder vessel from the ophthalmic artery. We highlight this case, to bring to light the deceptive diagnosis and management of recurrent and refractory AVM due to a feeder vessel from the ophthalmic artery.