A Case of Orbital Granuloma Secondary to Dermal Filler Injection.

A foreign body granulomatous reaction is a rare complication of the subcutaneous injection of fillers. We describe a 57-year-old female that presented with a six-month history of a non-painful, right lower eyelid mass. She had a dermal filler in the zygomatic region several months before the onset of her symptoms. Anterior orbitotomy and pathology revealed multinuclear giant cells consistent with a hyaluronic acid-based filler. This case describes the clinical presentation, histopathologic features, and treatment of an orbital granuloma secondary to dermal filler injection. Our case was uncommon because the zygomatic filler migrated across the orbital septum. Additionally, transconjunctival orbitotomy was used instead of a hyaluronidase injection due to the inferior location of the granuloma.

Indications for orbital exenteration in mucormycosis.

PURPOSE: To determine whether evidence-based standards exist regarding the indications for orbital exenteration in patients with orbital mucormycosis. METHODS: A literature review was performed of 113 articles (1943 to 2004). Factors possibly related to patient survival were analyzed. Additionally, a survey was sent to all ASOPRS Fellowship Preceptors to ascertain the frequency, outcome, treatment modalities, and indications for exenteration by these practicing physicians. RESULTS: For published cases, parameter estimates (PE 46 years, frontal sinus involvement, and fever were less likely to survive compared with patients without these conditions. Patients treated with amphotericin B (OR, 4.476) and those with diabetes (OR, 4.987) were more likely to survive compared with patients without these conditions. Exenterated patients with fever were more likely to survive compared with nonexenterated patients with fever (P=0.0468). Thirty-four ASOPRS Fellowship Preceptors received surveys; 26 (76%) completed the survey. Responses to specific survey questions showed a varied experience and indication for exenteration throughout the country. CONCLUSIONS: : Our study underscores the lack of adequate data regarding the evaluation of treatment of orbital mucormycosis. No standard of care currently exists to guide physicians on when exenteration may benefit a mucormycosis patient. Further study is needed to determine which variables indicate the extent of disease and which variables or analytic scheme might predict the progression of orbital mucormycosis with or without exenteration.

Adverse reactions to permanent eyeliner tattoo.

PURPOSE: To report the potential for serious adverse reactions associated with permanent eyeliner tattoos. METHODS: An observational case series was conducted on 4 patients who presented with inflammatory eyelid reactions after receiving permanent eyeliner tattoo. RESULTS: Clinically, the tattoo-associated lesions were typically firm, raised masses underlying the areas of pigmentation. Histopathologic analysis of tissue from all 4 patients demonstrated a granulomatous inflammatory response with negative cultures for any organisms. Treatment approaches varied between a combination of topical steroid creams, local steroid injections, local resection, intramuscular steroid injection, and systemic oral steroids. These treatments were successful in all 4 cases. CONCLUSIONS: An allergic granulomatous reaction is one of the adverse reactions seen after permanent eyeliner tattoo. Treatment can be challenging and may ultimately require excision of tattoo pigment to remove the inciting factor. Systemic steroids may aid in controlling the inflammation associated with reaction to the tattoo pigment.