Subconjunctival Swelling — Prolapse of Orbital Fat

Abstract

images in clinical medicineT h e ne w e ngl a nd jou r na l o f m e dic i ne n engl j med 356;1 www.nejm.org january 4, 2007 67A 59-year-old nonobese man presented with a 7-year history of gradually progressive swelling over the left eye. He had no other clinically significant medical history or history of trauma. There was a soft, yellowish mass in the outer temporal subconjunctival region (Panel A). The patient's vision was normal. Among the disorders in the differential diagnosis, orbital lymphoma was a particular concern. Characteristic features of an orbital lymphoma typically include a lesion of salmon color that is firm on palpation, that has a solid appearance on computed tomography (CT), and that follows the contour of the orbit without bony erosion. The mass was reducible on direct pressure, and it enlarged on retropulsion of the globe (Panel B), suggesting the fluid nature of its content and intraorbital extension. CT revealed a density identical to that of intraorbital fat, confirming the clinical impression of subconjunctival prolapse of orbital fat -a benign entity. Surgical intervention may be needed if such a lesion is cosmetically unacceptable or causes discomfort. Clinical recognition of this condition can spare the patient an extensive lymphoma workup, a biopsy, and further follow-up.

Subconjunctival orbital fat prolapse and thyroid associated orbitopathy: a clinical association

“…Although subconjunctival fat prolapse is reported in case reports 13 , 20 or small case series 12 , 14 , 15 , 17 , 18 as a rare entity, there are no data in the literature accessible to us on its incidence in the general population to compare with the 3.03% rate we noted among our TAO patients. The clinical manifestations of TAO may be encountered at variable frequencies ranging from 92% of patients developing upper eyelid retraction during the course of their disease to 3.3% developing superior limbic keratoconjunctivitis in the large prospective study by Bartley.…”

“…It typically occurs in the lateral canthal area beneath the temporal or superotemporal bulbar conjunctiva as a soft yellowish mass with a convex anterior margin and faint superficial blood vessels. 14 , 15 , 17 – 20 It is usually bilateral, but may also be unilateral. As the extension of prolapsed fat is often asymmetric, minor lesions in the contralateral eye may be sometimes overlooked.…”

Diagnosis and Excision of Subconjunctival Herniation of Orbital Fat

“…5,6 Patients often present with cosmetic complaints and may also experience symptoms of dryness or discomfort. 2,4 If the lesion is large enough, it may cause formation of corneal dellen (distinct areas of corneal tissue thinning because of dehydration) secondary to exposure keratopathy. 7 Although subconjunctival HOF is considered a benign lesion, it does mimic several other ocular conditions such as dermolipoma, pleomorphic lipoma, atypical lipomatous tumor, conjunctival lymphoma, and lacrimal gland prolapse.…”

“…1 It typically manifests as a yellowcolored mass located superotemporal beneath the conjunctival tissue. 1,4,5 Subconjunctival HOF is assumed to occur because of a dehiscence of the Tenon capsule whether caused by age, injury, or surgery. 1Y3 This weakening of the Tenon capsule allows the intraconal orbital fat to protrude anteriorly and can occur unilaterally or bilaterally.…”