Ulcerative granuloma of the eyelid as the initial manifestation of granulomatosis with polyangiitis (Wegener's granulomatosis): A case report.

A 56-year-old-man presented a 2-month history of chalazion in the eyelids without response to treatment and with an inconclusive biopsy. Laboratory results confirmed the presence of Enterobacter cloacae and Streptococcus gordonii infection. Despite appropriate intravenous antibiotic treatment, clinical worsening was observed. Radical surgical excision and total tarsorrhaphy were performed. Following treatment, the patient was asymptomatic for 6 weeks until he developed acute renal failure, generalised arthralgia, acute hypertensive anterior uveitis, and dacryoadenitis. Lacrimal gland biopsy revealed a perivascular granulomatous inflammation with necrotic foci. Renal biopsy showed a necrotizing extracapillary glomerulonephritis. Blood tests showed elevated levels of C-reactive protein, positive rheumatoid factor, and proteinase 3-anti-neutrophil cytoplasmic antibody. The patients was therefore diagnosed with granulomatosis with polyangiitis and treated with cyclophosphamide and corticosteroids, with good systemic and orbital response. Surgical reconstruction of the eyelid was subsequently performed. This case describes, for the first time in the literature, an eyelid granuloma as the presenting sign in GPA, highlighting the importance of differential diagnosis of eyelid lesions with unusual characteristics.

Pericranium grafts for exposed orbital implants: An observational case-series study.

OBJECTIVE: The aim of this article is to highlight our experience with autologous pericranium graft in wide exposures (≥3 mm). The pericranium graft was taken from the parietal region of the scalp in six consecutive clinical cases of orbital implant exposure in anophthalmic sockets. MATERIAL AND METHODS: This is a prospective, descriptive case series study of patients who had orbital implant exposures and were treated with autologous pericranium graft. RESULTS: The average postoperative follow-up period was 10 months, and the mean time for conjunctivalization of the graft was 3 months. In all cases, complete conjunctivalization was achieved, and no re-exposure of the implant was observed. CONCLUSIONS: The pericranium graft from the parietal region is an effective technique to treat both small and large orbital implant exposures with no comorbidity. Time to complete conjunctivalization is similar to that of other autologous grafts. It is a simple and convenient method for the oculoplastic surgeon that constitutes a good alternative for covering anophthalmic cavities. Further studies with more cases and longer follow-up are required to confirm the effectiveness of this technique.