Eyelid lipoid granuloma following topical ointment application

Periocular petrolatum

PURPOSE

This report describes the clinical and histopathologic features and discusses the diagnostic difficulties and management of periocular deposition of petrolatum-based materials.

METHODS

Excision of orbital and eyelid tissue, tissue processing, and histopathologic examination was performed in patients with deposition of petroleum-based products. Transmission electron microscopy was performed in 3 cases.

RESULTS

Between 1983 and 2003, 11 patients were diagnosed with periocular petrolatum deposition, based on clinical history and the characteristic histopathologic features of polymorphic dropout spaces, and varied from a noninflammatory lesion (paraffinoma) to those with an associated granulomatous inflammatory reaction.

CONCLUSIONS

The diagnosis of petrolatum deposition can be challenging due to the range of symptoms and variable delay in presentation. Petrolatum products should be avoided during surgery and used judiciously in the postoperative period. To avoid confusion with nonspecific cases of lipogranulomatous inflammation, the terms "ointment granuloma" or "orbital paraffinoma" should be used to refer to patients presenting with orbital/eyelid lesions caused by ointment use.

Oleogranulomatous response in lymph nodes associated with emollient use in Netherton's syndrome

Paraffin-based emollients are widely used in dermatological practice and are not usually absorbed through the skin. We report a case where transcutaneous transfer did occur in the context of damaged skin in Netherton's syndrome, resulting in a reversible lymphadenopathy.

Paraffin induced sclerosing lipogranuloma of eyelids and anterior orbit following endonasal sinus surgery

During the past 5 years we have seen 10 patients who had developed sclerosing lipogranuloma of the lid and orbit after endonasal sinus surgery with subsequent ipsilateral monocular haematoma. The histopathological examination of all and the additional nuclear magnetic resonance spectroscopic examination of four surgical specimens in combination with the typical clinical course led to the conclusion that the granulomas were caused by small paraffin droplets. These in turn stemmed from the ointment plugs applied to the sinuses at the end of the operation, and were washed out into the surrounding tissues by the postoperative haemorrhage. As the chronic and recurring granulomas can lead to considerable cosmetic and functional impairment, the application of ointment plugs at the end of sinus surgery should be abandoned, especially when peri- or postoperative bleeding occurs.