Pyogenic granuloma of the cornea induced by "snake oil"

Corneal pyogenic granuloma: rare complication of infectious keratitis

Background

Pyogenic granuloma is an excessive proliferation of granulation tissue that usually develops after minor trauma or surgery. Ocular involvement usually happens on the external surface and cornea is rarely involved. The objective of our report is to describe the clinicopathological feature of this rare disease and give insight on clinical features that help in the diagnosis.

Case Report

This report presents a case of a four year old child who had fleshy growth of one week duration on the right eye after seven weeks of pain and redness. Slit lamp examination showed vascularized central corneal mass with surrounding stromal infiltrates. The mass was excised, and histopathological examination confirmed pyogenic granuloma of the cornea.

Conclusion

Corneal pyogenic granuloma could be a rare complication of infectious keratitis. Therefore, it should be considered as a differential diagnosis in corneal mass especially after an infection or trauma.

Pyogenic granuloma of the cornea

BACKGROUND

Ocular pyogenic granulomata are uncommon and are often associated with a chalazion or previous ocular and adnexal surgery The avascular nature of the cornea may explain the rarity of pyogenic granulomata at this site. We report on a case of corneal pyogenic granuloma following previous corneal surgery.

METHODS

Ophthalmologists who had treated the patient previously were contacted and earlier clinical notes and histopathological examinations were reviewed. The clinical course following excision of the pyogenic granuloma is described, as are the histopathological findings.

RESULTS

Histological examination confirmed the diagnosis of pyogenic granuloma. Excision was followed by a clinical recurrence at a different site with spontaneous resolution.

CONCLUSIONS

Pyogenic granulomata of the cornea are rare. However, the present case illustrates the importance of considering benign inflammatory causes in the differential diagnosis of a corneal mass lesion so as to avoid unnecessarily aggressive intervention. To our knowledge, spontaneous resolution of a corneal pyogenic granuloma has not been previously described.

Pyogenic granulomas of the cornea

BACKGROUND

Pyogenic granulomas are vascular inflammatory lesions that represent an aberrant wound healing response. They typically arise from mucous membranes or skin. Pyogenic granulomas primarily involving the cornea have been rarely reported.

METHODS

Between January 1983 and July 1994, 14 patients with histologically proven pyogenic granulomas of the cornea were treated.

RESULTS

The precipitating event was a persistent epithelial defect in nine patients. Ocular surface disease was present in all patients. Predisposing conditions included indolent corneal ulceration, cry eye syndrome, trachoma, trichiasis, alkali burn, multiple topical drug use, previous orbital irradiation, and ocular cicatricial pemphigoid.

CONCLUSIONS

Ophthalmologists should be aware that pyogenic granulomas may involve the cornea and include this entry in the differential diagnosis of tumors involving the limbus or cornea. The typical clinical appearance, rapid growth, minimal staining with rose bengal dye, response to topical steroids, and associated ocular surface disease help to distinguish this lesion from a neoplastic epithelial tumor of the conjunctiva or cornea.