Massive Silicone-Induced Orbital Granuloma

Abstract

We report a large subconjunctival-orbital granuloma in a 51-year-old male presenting with a blind painful right eye and marked chemosis 15 months after undergoing vitrectomy and silicone oil retinal tamponade for retinal detachment with no reported intraoperative complications. Gross and histopathologic examination of the enucleated eye and episcleral tumor revealed a bosselated mass measuring 17 × 10 × 5 mm containing prominent vacuoles with surrounding epithelioid histiocytes and foreign body multinucleated giant cells. Such a large silicone-induced orbital granuloma following uncomplicated retinal surgery in a grossly intact eye has not been previously reported to the authors’ knowledge. High intraocular pressure and emulsification of oil may facilitate silicone extravasation through scleral wounds after retinal surgery.

Large Subconjunctival Mass in a Patient With a History of Multiple Previous Ocular Surgeries

“…To our knowledge, this is one of the largest subconjunctival silicone oil granulomas described in the literature, and it is a reminder to surgeons that silicone oil can migrate with scleral melt, with globe rupture, through both sutured and unsutured sclerostomies, and with or without a glaucoma implant . Silicone oil migration is more likely when there is no lens, can occur even with inferiorly placed glaucoma implants, and has been reported for both valved and nonvalved implants .…”

Foreign body giant cell reaction to silicone oil presenting as a salmon-patch conjunctival lesion

“… 5 Orbital migration has been associated with chemosis, extraocular muscle limitation, and globe dystopia. 6 , 11 Ptosis has been reported in cases of eyelid involvement. 4 , 5 A significant granulomatous response has been documented in eyes with glaucoma shunt devices, as the tube appears to serve as a conduit of the oil from the vitreous into the subconjunctival space.…”

“…As conjunctival, eyelid, and orbital migration of oil can manifest with a variety of undesirable signs and symptoms, 3 , 4 , 6 , 8 , 9 , 10 , 11 there may be benefit in early removal of the source (intraocular silicone oil), closure of the potential shunt (leaky scleral wounds or glaucoma drainage devices), and excision of areas with oil collection or emulsification once a granuloma develops. Tight, self-sealing incisions, surgical maneuvers that minimize scleral stretching, and normalization of intraocular pressure before removal of ports can also decrease the risk.…”

“…1 Although it is considered an ideal intraocular implant, silicone oil has been observed to emulsify within ocular tissue, causing complications such as cataract, corneal decompensation, and glaucoma, among others. 1 Migration of silicone oil to extraocular structures has caused conjunctival inflammation, 3 ptosis, 4 , 5 and orbital signs 6 in previous reports. We describe a unique case of foreign body reaction to silicone oil presenting as a salmon-patch lesion on the conjunctiva.…”

Unilateral eosinophilic cellulitis leading to implant extrusion after bilateral enucleation in a dog

“… 26 Suture, gauze fragments, and other surgical debris have been implicated in orbital mass lesions in people, but histopathology from those lesions is usually characterized by the presence of giant cells and classical granulomas, both of which were lacking in this patient. 27 , 28 , 29 , 30 While no foreign material was evident either grossly or microscopically, it is still possible that gauze fibers, resorbing polyglactin suture, or debris associated with the implant were present and were not captured during sectioning or were lost when the implant was extruded.…”