Early results of surgical management of conjunctival dermolipoma: partial excision and free conjunctival autograft

Choi, Youn Joo; Kim, In Hyuk; Choi, Jeong Hoon; Lee, Min Joung; Kim, Namju; Choung, Ho Kyung; Khwarg, Sang In

doi:10.1136/bjophthalmol-2014-306328

Cited by 11 publications

(4 citation statements)

References 13 publications

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“…The surgeon must also be cautious about damaging the medial rectus, inferior rectus, and inferior oblique muscles. Dermolipoma has a very low potential for malignant transformation, hence periodic monitoring mainly for postoperative complications, such as forniceal shrinkage and strabismus, is recommended [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

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Dermolipoma in an Unusual Location: A Case Report and Literature Review

Someda,

Takahashi

2023

Cureus

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A healthy nine-year-old Japanese male presented with a history of inferonasal conjunctival mass that was noted to increase in size in a few years' time. Initial examination revealed a 10-mm soft yellowish inferonasal conjunctival mass with a whitish surface. The rest of the examination findings were unremarkable. A computed tomographic scan was done and showed a conjunctival mass that was not connected posteriorly to the orbital fat but had the same density as the orbital fat. Complete surgical excision was performed, and pathologic evaluation of the excised specimen revealed a dermolipoma. The patient was subsequently followed up to monitor for any postoperative complications. Three months following the operation, there was no recurrence of the tumor, and the patient had an excellent cosmetic outcome.

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Section: Discussionmentioning

confidence: 99%

“…Dermolipoma is the second most common conjunctival mass in children and is the most common epibulbar choristoma [1]. It is a benign mass composed of adipose tissue with keratinized stratified squamous epithelium and is usually located in the superotemporal conjunctival fornix [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Dermolipoma in an Unusual Location: A Case Report and Literature Review

Someda,

Takahashi

2023

Cureus

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“…Tension-free closure of the defect after excision of large dermolipomas can be difficult, and free conjunctival grafts or upper bulbar rotational flaps have been suggested for such cases; 6,7 these approaches will, however, lead to donor-site scarring which—in the upper fornix—is likely to impair upper eyelid movement and cause ptosis and might additionally interfere with future glaucoma surgery. 8 In contrast, we find that a “V-to-Y” conjunctivoplasty works well: the horizontal arm of the closure reduces symblepharon to the outer canthus (and consequent restriction of eye movements) and the remaining bulbar area is generally amenable to closure with the other 1 arms of the “Y,” and with small areas of secondary intention healing if needed.…”

Section: Discussionmentioning

confidence: 99%

“…Damage to the neighboring lacrimal gland ductules, Tenon’s sheath around lateral rectus, or upper fornix is best avoided by use of magnification during surgical microdissection. 2,3,6 Extensive resection may be required with large areas of dermis, this often limiting direct closure without tension, and several reconstructive methods have been proposed for such defects—such as conjunctival rotation flaps, autografts, or substitutes; 6,7 many of these techniques subject the neighboring normal tissues to wide mobilization and associated donor-site morbidity.…”

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confidence: 99%

The Presentation and Surgical Treatment of Peribulbar Dermolipomas

Vahdani

Rose

2020

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: To evaluate the presentation, treatment, and outcome for patients with peribulbar dermolipomas and describe a reliable technique for excision of large lesions. Patients and methods: Retrospective chart review for patients seen at Moorfields Eye Hospital between 1976 and 2019. Patient demographics, clinical features, imaging (CT or MRI, where available), histopathology, and surgical outcomes were reviewed. Results: One hundred and ninety-six eyes of 187 patients (117 females; 63%) were identified as having dermolipoma, the patients presenting at an average age of 21.5 years and—where recorded in 163 patients—had first symptoms at an average age of 12.9 years. Although 8/187 (4%) patients were asymptomatic, the commonest symptom was increasing size of a longstanding peribulbar lump (136 patients; 73%); other symptoms included ocular irritation (24%), episodic localized conjunctival injection (12%), and mucoid discharge (12%). One-third of dermolipomas had visible hairs (some with localized giant papillary conjunctivitis), lateral canthal widening was present in 44 patients, aberrant lacrimal gland ductules opening onto skin in 8, and a complex lateral canthal anomaly—with both an external dermoid and an internal dermolipoma—was present in 9 patients. Complete management details were available for 120 patients (those treated after 1990) and 40 (33%) electing for observation, 71 (59%) had excision for long-term irritation and discharge and 9 (8%) for cosmesis: together with the integral subdermal fat lobule, in all cases the abnormal, nonwetting squamous epithelium was delineated and excised under microscopic control, and the conjunctival defect closed directly (59/80 eyes) or with a “V-to-Y” closure (21 eyes; 26%). The presenting symptoms were cured in all except 1 patient, who required excision of residual abnormal epithelium causing persistent symptoms. Two patients developed symblepharon to the lateral canthus after direct conjunctival closure, this having no functional effect, and 2 other patients had slight restriction of extreme horizontal gaze. Conclusion: Dermolipomas may require surgery when they become more prominent with age, or start causing ocular irritation and discharge. Complications are few with meticulous removal of the nonwetting squamous epithelium and direct conjunctival closure, or when using a “V-to-Y” conjunctivoplasty for larger defects.

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