Conjunctival Granuloma

Authors: 

LCDR JEFFREY ANT, DDS, MD

Two months after undergoing bilateral transconjunctival blepharoplasty, a 48-year-old man presented with dryness and pruritus of the left eye of 1 week's duration. He denied any discharge, change in vision, or fever.

Visual acuity and papillary response were normal. No purulent discharge, erythema, pain with extraocular movements, or photophobia was present. The orbit was intact without crepitus or gross deformity. A mild fullness inferior to the left eye was noted. Retraction of the lower lid revealed a mobile, flesh-colored, pedunculated mass.Because of the mass effect and irritation caused by the lesion, it was excised under local anesthesia. The patient's symptoms subsequently resolved. Histopathological findings confirmed the clinical suspicion that the mass was a granuloma.

Complications of transconjunctival blepharoplasty are rare.1,2 In one study, conjunctival granulomas developed in 8 of 400 patients who underwent the procedure.3 A granuloma may result from intraoperative trauma, a foreign body, inflammation,4 hematoma, excessive subconjunctival edema, or impaired closure of the incision.5 The type of suture is not a factor; granulomas have developed when no sutures are used.3 Patients are often asymptomatic5; however, they may present with excessive dryness, tearing, a fullness inferior to the eye, pruritus, or a foreign body sensation.3

The first step in treating a granuloma caused by transconjunctival blepharoplasty is to remove any foreign bodies or sutures. If the granuloma protrudes outside the eyelid or causes a mass effect or irritation, it should be excised. Otherwise, a trial of an ophthalmic corticosteroid solution may be used for short-term initial management.1 Refer patients who require topical corticosteroid therapy for more than 2 weeks to an ophthalmologist to monitor intraocular pressure.3 *

References: 

1. Glavas IP. The diagnosis and management of blepharoplasty complications. Otolaryngol Clin North Am. 2005;38:1009-1021.
2. Soll SM, Lisman RD, Charles NC, Palu RN. Pyogenic granuloma after transconjunctival blepharoplasty: a case report. Ophthal Plast Reconstr Surg. 1993;9:298-301.
3. Mullins JB, Holds JB, Branham GH, Thomas JR. Complications of the transconjunctival approach. A review of 400 cases. Arch Otolaryngol Head Neck Surg. 1997;123:385-388.
4. Ferry AP. Pyogenic granulomas of the eye and ocular adnexa. Trans Am Ophthalomol Soc. 1989; 87:322.
5. Fryer RH, Reinke KR. Pyogenic granuloma: a complication of tranconjunctival incisions. Plast Reconstr Surg. 2000;105:1565.