A healthy 18-year-old male with a history of autism presents with periorbital swelling and unintentional weight loss during the preceding 6 months. He and his family report swelling around his eyes, which has not responded to topical and systemic therapies for ocular allergy, including topical ketotifen and olopatadine as well as loratadine and cetirizine. He denies a history of seasonal allergies, current conjunctival irritation, eye pain, or changes in vision. Since the onset of eye swelling 6 months ago, his father also reports that the patient has unintentionally lost 30 lb. He denies abdominal pain and nausea, his appetite is unchanged, and he has not had any change in his stools. Review of systems is otherwise negative. He has normal vital signs. On examination his bilateral eyelids and area overlying the bilateral lacrimal glands are swollen and mildly erythematous but nontender to palpation. He has no evidence of conjunctivitis; his...

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