Conjunctival Granuloma Research Articles

Temporarily attached conjunctival flap for primary pterygium surgery

Purpose The aim of the study was to evaluate the safety and outcomes of recurrent pterygium excision with a temporarily attached rotational conjunctival flap. Patients and methods In an interventional case series, consecutive patients with recurrent pterygium underwent surgical excision with temporary attachment of a rotational conjunctival flap onto bare sclera. Patients were followed up for 6-12 months and the results were evaluated in terms of recurrent pterygium growth and complications. Results Thirty eyes from 30 consecutive patients (19 male and 11 female) of a mean age of 43.3 ΁ 10.8 years were operated upon. The pterygia extended 4.6 ΁ 1.2 mm (range 3-6 mm) onto the corneas. Two eyes (6.6%) showed recurrent pterygium growth. One eye (3.3%) developed conjunctival granuloma, which eventually required excision, leading to complete resolution. Conclusion Pterygium excision with a temporarily attached rotational conjunctival flap is a safe, easy, and effective surgical technique in the management of recurrent pterygium and has a low recurrence rate.

Granulomatous conjunctivitis associated with chronic blepharitis in children

AbstractPurpose To outline the clinical and pathological characteristics of granulomatous conjunctivitis associated with primary chronic blepharitis in childrenMethods 23 children presenting ocular rosacea with suspected conjunctival granulomas were examined prospectively. Conjunctival biopsies were performed in 20 patients; for each sample we associated histological study with an immunohistochemistry analysis (CD3, CD4, CD8, CD1a, CD11c, CD68, CD123).Results Conjunctival inflammation was micronodular, associated with follicles in 4 cases. Conjunctival granulomas appeared as whitish or subtle yellowish nodules. Corneal complications were common (87%), as phlyctenular lesions (43.5%) and neovascularization (69.5%). Epithelioid granulomas associated with giant cells infiltrated the conjunctival matrix of most patients (80%), inflammatory infiltrate only was found for 4 patients. The granulomatous specimens showed peri‐ and intra‐granulomas infiltration by inflammatory T‐cells (CD3), with more CD4 cells than CD8 cells, monocytic‐derived cells (CD11c) including macrophages (CD68+ CD1a), and less frequently plasmacytoid dendritic cells (CD123). Treatment included topical steroids, lubricants and eyelids care (100%), topical ciclosporine (13%), systemic antibiotics (35%).Conclusion Granulomatous conjunctivitis is a complication of ocular rosacea in children. The immunopathology of the conjunctiva identified the main cellular actors involved in the granulomatous process. Our results provide a new look on this pathology.

Ocular granulomatosis associated with brimonidine treatment. Does brimonidine have an effect on human macrophages and dendritic cells in vitro?

AbstractPurpose Conjunctival and episcleral granulomas with uveitis have been reported as a side effect of antiglaucomatous topical use of brimonidine tartrate. We postulated that brimonidine is implicated in this inflammatory process and studied its effects on the antigen presenting cells (APCs) cytokines production.Methods Conjunctival and episcleral granulomatous lesions were immunohistochemically analyzed for CD3, CD4, CD8, CD1a, CD11c, CD68, and CD123. Macrophages and dendritic cells (DCs) were generated from peripheral blood monocytes of healthy donors and of patients who presented uveitis and granulomatous ocular infiltration induced by brimonidine topical treatment. APCs were respectively exposed to preserved and unpreserved brimonidine tartrate suspension(0.012%),0.005% benzalkonium chloride (BAK) and lipopolysaccharides (LPS). APCs Th1/Th2 cytokines production was measured in supernatants by multiplex flow cytometry.Results The granulomas consisted predominantly of CD4+ T‐cells and APCs, i.e. epithelioid macrophages CD 68+ and myeloid DCs CD11c+. Comparative exposure of APCs to unpreserved or preserved brimonidine tartrate formulations, or BAK alone, induced similar amounts of pro (IL‐6 or TNF‐α) and anti (IL‐10) inflammatory cytokines. Brimonidine tartrate and BAK reduced the LPS‐stimulated production of IL‐6, TNF‐α and IL‐10.Conclusion The histhopathological analysis of the conjunctiva and the episclera identified the main cellular actors involved in the granulomatous inflammatory process. By altering the APCs IL‐10 production, brimonidine tartrate will affect induction of tolerance by DCs and allow initiation of immune response leading to granulomas formation.

« Teddy bear granuloma », une pathologie rare : à propos du cas d’un enfant de trois ans

Conjunctival synthetic fiber granulomas, or "Teddy bear granulomas", are rare granulomatous responses to synthetic fabric fibers. We report the case of a 3-year-old boy with no prior infectious or traumatic history, brought in by his parents for an incidentally discovered conjunctival growth in his right eye. Slit lamp examination revealed a 10-mm growth in the inferior fornix surrounding a small greyish foreign body. Surgical excision and histopathology revealed granulomatous inflammatory cell response with foreign body giant cells surrounding exogenous material. This foreign material was birefringent in polarized light, very suggestive of synthetic fabric fibers, which permitted the diagnosis of Teddy bear granuloma. Synthetic fiber granulomas present in children as unilateral, more or less inflammatory growths in the inferior conjunctival fornix. Surgical excision with histopathology makes the diagnosis and effects the cure.

A new lacrimal bypass tube fixation method to prevent tube displacement in conjunctivodacryocystorhinostomy (CDCR)

AimsTo evaluate the efficacy of a new lacrimal bypass tube fixation technique to the conjunctiva and caruncle, preventing postoperative displacement of the tube in conjunctivodacryocystorhinostomies (CDCRs).MethodsThe authors conducted 52 CDCR...

Ocular surface squamous neoplasia in xeroderma pigmentosum: clinical spectrum and outcome

To study the clinical spectrum and therapeutic outcome of ocular surface squamous neoplasia (OSSN) in patients with xeroderma pigmentosa (XP). The authors performed a retrospective review of records of patients with xeroderma pigmentosa referred to Cornea Services for management of OSSN. Presenting symptoms, clinical features, tumour morphology and location, treatment modalities, recurrence rates and visual outcome were noted. Seven patients of XP (six males; one female) with bilateral OSSN were included in the study. All patients were less than 15 years of age at presentation, with 13 of 14 lesions of OSSN (93%) occurring at the limbus. Associated ocular features were limbal stem cell deficiency in nine eyes (64.3%), dry eye in all 14 eyes (100%), conjunctival melanosis in seven eyes (50%), pseudopterygium in two eyes (14.3%), anterior symblepharon in three eyes (21.4%) and conjunctival inflammatory granuloma in one eye (7.1%). Unaided visual acuity in the 14 eyes ranged from 6/6 to 6/36 at presentation. Six of the 14 eyes (42.9%) had histopathological features of invasive squamous cell carcinoma, and eight eyes (57.1%) demonstrated features consistent with conjunctival intraepithelial neoplasia. Recurrence was seen in nine of 14 eyes (64.3%). OSSN occurs predominantly in the elderly, but in patients of XP it tends to occur at a younger age (6-22 years). The disease appeared to be more aggressive (recurrence rate = 64.3%) than usual. Awareness and prompt management with close follow up is warranted in these patients.

Ocular Sarcoidosis

A 13-year-old adolescent was admitted to our clinic with a history of otalgia, odinophagia, and subconjunctival hemorrhage (red eye). After the patient had used ophthalmic tobramycin/dexamethasone and oral amoxicillin for 3 days, prescribed when she was seen in an emergency service, the conjunctival lesion had not improved. On admission, examination of the patient revealed unilateral temporal nodular episcleritis (Table) of her left eye (arrow), arthritis of her left ankle, symmetric erythema nodosum on her legs, and a fever (temperature, 38°C). Ocular sarcoidosis was diagnosed by conjunctival biopsy; the specimen showed a noncaseating granuloma. Culture was negative for bacteria, fungus, and parasites. The patient had no reaction to the tuberculin test, had no signs of intrathoracic disease, and the levels of the angiotensin-converting enzyme as well as serum and urinary calcium were normal. The lesion resolved after 2 months of treatment with ophthalmic dexamethasone.TABLECauses of EpiscleritisData from Br J Ophthalmol.1Watson PG Hayreh SS Scleritis and episcleritis.Br J Ophthalmol. 1976; 60: 163-191Crossref PubMed Scopus (386) Google Scholar Collagen vascular diseases (ie, rheumatoid arthritis, systemic lupus erythe-matosus, polyarteritis nodosa, and spondyloarthritis)GoutInfectious diseases (tuberculosis, Lyme disease, syphilis)Granulomatous diseases (Wegener granulomatosis, sarcoidosis) Open table in a new tab Sarcoidosis is less common in children than in adults. In a 15-year study in Denmark, the incidence of sarcoidosis was 0.06 case per 100,000 children 4 years of age oryounger; it increased gradually with age to 1.02 cases per 100,000 adolescents 14 to 15 years of age. In adolescents, the clinical picture was similar to that in adults.2Iannuzzi MC Rybicki BA Teirstein AS Sarcoidosis.N Engl J Med. 2007; 357: 2153-2165Crossref PubMed Scopus (1610) Google Scholar Uveitis or iritis is the most common manifestation, occurring in 24% to 56% of children, followed by conjunctival granulomas.2Iannuzzi MC Rybicki BA Teirstein AS Sarcoidosis.N Engl J Med. 2007; 357: 2153-2165Crossref PubMed Scopus (1610) Google Scholar, 3Shetty AK Gedalia A Childhood sarcoidosis: rare but fascinating disorder.Pediatr Rheumatol Online J. 2008; Sep 23; 6: 16Crossref PubMed Scopus (116) Google Scholar

Transconjunctival approach in orbital traumatology: A review of 56 cases

Aim The aim of this study is to analyze the transconjunctival approach in the treatment of orbital fractures and to evaluate the indications, the advantages of the surgical approach, and the occurrence of possible complications. Materials and methods From 2005 to September 2009 we used a transconjunctival approach on 53 patients for a total of 56 cases of orbital fractures (three cases with bilateral floor fractures), 54 cases of acute trauma, and two outcomes of previous fractures. We evaluated the incidence of intra or postoperative complications and in the postoperative follow-up we investigated the presence of: entropion, ectropion, scleral show, trichiasis, conjunctival granuloma, mobilization or exposure of orbital reconstruction material. Results In 56 cases we had four temporary postoperative complications and no long-term complications; two cases of trichiasis and two cases of partial entropion were treated only with medical therapy. All complications, as described in the literature, were transitory and did not require corrective surgery. Conclusion The transconjunctival approach is the most effective surgical access, not only to the medial orbital wall, but also to the orbital floor, as it does not interfere with the lachrymal drainage system and gives as wide a visualization of the orbital floor as does the palpebral approach. This surgical approach is simple to perform and gives good functional and aesthetic results.

The Expression of STAT-1 and Phosphorylated STAT-1 in Conjunctival Granulomas

Purpose: Sarcoidosis is a granulomatous inflammatory disease whose cause is unknown. Based on gene expression profiles of peripheral blood and on immunostaining of lymph nodes from sarcoidosis patients, the authors recently implicated the transcription factor STAT-1 in the pathogenesis. They explored the potential contribution of STAT-1 in an ocular manifestation of this disease.Methods: Conjunctival biopsies from 4 subjects with known sarcoidosis and from 8 subjects with conjunctival granulomas presumed from causes other than sarcoidosis were immunostained for STAT1.Results: STAT-1 was readily detectable in all biopsies from patients with sarcoidosis and in 3 controls. The activated form of STAT-1, phosphorylated STAT-1, was also more frequently detected in tissue from subjects with sarcoidosis relative to controls.Conclusions: The activities of STAT-1 in regulating the inflammatory response suggest that it contributes to the conjunctival granulomas characteristic of sarcoidosis, but its expression is not specific for either sarcoidosis or all granulomatous conjunctival disease.

Delayed adjustable sutures: a multicentred clinical review

PurposeTo characterise the results of the largest patient series to date undergoing closed conjunctival delayed adjustable suture techniques.MethodsA multicentre retrospective review of 440 operations (patients aged 10–91 years) by five...

Effectiveness of intra-operative Mitomycin-C in reducing the recurrence of pterygium in Irrua, Nigeria

To evaluate the effectiveness of intra-operative Mitomycin-C application after pterygium surgery in Irrua, Nigeria. The medical records of all patients who had pterygium excision with intra-operative application of 0.4mg/ml Mitomycin C between June 2002 and May 2007 and followed up for at least a year were reviewed. Two hundred and forty three eyes (196 patients) had pterygium excision with intra-operative application of 0.4mg/ml Mitomycin C over this period. Male to female ratio was 2:1. The mean age of the patients was 47.1years (SD+ 15.4) Eleven eyes had recurrence after a minimum follow up period of one year. Six (54.5%) out of the eleven eyes that had recurrence had conjunctival granuloma and in such cases recurrence was early (between 2 to 3 months of surgery). Conjunctival granuloma was the main complication occurring in 35 eyes (14.4%). Occurrence of granuloma was significantly associated with recurrence (P =0.0006). Delayed wound healing occurred in 5 eyes (2.1%). There was no case of either scleral or corneal melting. Intra-operative application of 0.4mg/ml Mitomycin C is very effective in reduction of recurrence of pterygium after excision. Hence patients should be given the benefit of intra-operative use of Mitomycin C during pterygium surgery.

Comparison of mitomycin C and limbal-conjunctival autograft in the prevention of pterygial recurrence in Turkish patients: A one-year, randomized, assessor-masked, controlled trial

Background: A pterygium is a fibrovascular overgrowth of degenerative bulbar conjunctival tissue that grows over the limbus onto the cornea. Although various approaches have been proposed for the treatment of pterygium, the common problem after these treatments is recurrence. Objectives: The goals of this study were to compare the efficacy of mitomycin C (MMC) and limbal-conjunctival autograft (LCAU) in preventing recurrence of primary pterygia and to monitor long-term adverse effects (AEs). Methods: Patients undergoing pterygium surgery between February 2006 and May 2007 were assessed prospectively and randomly divided into 2 groups using a random number table. The MMC group underwent pterygium excision and received 0.02% MMC intraoperatively for 2 minutes. The LCAU group underwent pterygium excision and LCAU. Recurrence and AE rates of the 2 treatments were compared during the 1-year follow-up period. Assessors for pterygial recurrence were masked to treatment group. Results: One hundred thirteen eyes (57 patients in the MMC group and 56 patients in the LCAU group) were included in the study. Thirteen of the patients (7 in the MMC group and 6 in the LCAU group) were withdrawn due to irregular attendance at follow-up visits or lack of sufficient dose and duration for postoperative topical antibiotic and steroid administration; their data were excluded from analysis. Fifty patients (MMC group: 26 men, 24 women; mean [SD] age, 48.0 [12.3] years; age range, 30–73 years; LCAU group: 27 men, 23 women; mean age, 49.0 [12.6] years; age range, 28–71 years) in each group completed the study. The mean (SD) length of the pterygium across the limbus was similar in the MMC group and the LCAU group (4.18 [1.27] vs 4.07 [1.24] mm). The mean follow-up period was also similar in the 2 groups (16.0 [1.9] vs 15.0 [1.7] months). The rate of recurrence was significantly greater in the MMC group than in the LCAU group (10 [20.0%] vs 2 [4.0%] patients; P=0.035). Seven patients (14.0%) in the MMC group experienced AEs: conjunctival cyst (3 patients), symblepharon (2), conjunctival granuloma (1), and dellen (1). In the LCAU group, 1 patient (2.0%; P=0.032 vs MMC group) experienced permanent graft edema. All patients in the LCAU group experienced transient graft edema, with recovery occurring in 3 to 4 weeks. There were no intraoperative complications and there was no graft rejection. Conclusions: Recurrence and postoperative AEs were less frequently observed in primary excision with LCAU than with MMC in these Turkish patients who completed the study. This study found that pterygium excision with LCAU was well tolerated and effective in these patients.

Selective Embolization and Resection of a Large Noninvoluting Congenital Hemangioma of the Lower Eyelid

To present a combined interventional radiologic and resection technique for the management of a large amblyogenic, highly vascular lesion of the lower eyelid associated with severe mechanical ectropion, conjunctival pyogenic granuloma, and recurrent, spontaneous conjunctival bleeding. Preoperative selective embolization and coil placement were followed by resection of the tumor. Embolization, coil placement, and resection were uneventful with cosmetic and functional visual improvement obtained. Pathology indicated a noninvoluting congenital hemangioma. To the authors' knowledge, this is the first surgical technique reported in the ophthalmic literature for the selective embolization of a noninvoluting congenital hemangioma prior to its resection. Such a technique should be considered in the management of large lesions of this type.

Posterior Lamellar Eyelid Reconstruction With Acellular Dermis Allograft in Severe Cicatricial Entropion

Severe cicatricial entropion is a serious condition, which may threaten the vision of the affected patient. To date, surgical repair of this condition has been difficult and associated with a high degree of failure. From February 2005 to February 2006, a prospective cohort study was conducted in which 14 patients with severe cicatricial entropion were recruited. Lengthening of the posterior lamella of the eyelid with acellular dermis allograft (ReDerm, Jieya company, Beijing, PR China) was performed followed by use of therapeutic contact lenses at the end of surgery. The patients were followed up regularly and were assessed for structural integrity, upper marginal reflex distance (U-MRD), vertical palpebral aperture, and lagophthalmos. The mean follow-up time was 18 months. Acellular dermis was effective in reducing the palpebral aperture (P = 0.002), lagophthalmos (P = 0.016), and lengthening the upper eyelid height by reducing U-MRD (P = 0.008). However, there were 2 cases of recurrence because of the shrinkage of graft (70%) and 3 cases of conjunctival granulomas postoperatively. Final outcome was good in 14 of 16 eyelids. We have found that acellular dermis grafting with insertion of therapeutic contact lenses is an effective and simple measure for rectifying severe cicatricial entropion both structurally and functionally.

Insect wing tarsal foreign body causing conjunctival granuloma and marginal keratitis

A 37 year old male was referred to our centre for management of episcleritis with peripheral keratitis in the right eye. He had a history of ocular discomfort in the right eye of 1 week duration. Slitlamp examination revealed marginal keratitis between 12'o clock to 2'o clock positions in the right eye. Lid eversion revealed an insect wing on the tarsal conjunctiva along with an adjacent conjunctival granuloma. The area of the marginal keratitis corresponded to the area of the foreign body and the conjunctival granuloma. The probable mechanism of the development of marginal keratitis and the conjunctiva granuloma is speculated in this case report.

Five-year Study of 120 Endoscopic Conjunctivodacryocystorhinostomy Using Porous Polyethylene-Coated Tear Drain

Purpose: To evaluate the long-term surgical results of 120 endoscopic conjunctivodacryocystorhinostomy (CDCR) procedures using a porous polyethylene (MEDPOR) coated tear drain (MCTD). Methods: From 2002 to 2007, 120 patients who had been treated with endoscopic CDCR using MCTD were investigated for its success rates and complications. After an osteotomy was made under nasal endoscopy, a tunnel was created from the caruncle in the conjunctival sac to the nasal cavity through the newly created ostium, and then the tunnel was enlarged to allow the insertion of the MCTD The length of the tube to be inserted was determined under endoscopic examination. An anchoring suture was placed at the medial canthus to both the conjunctiva and the skin using a 5-0 Vicryl suture in the fashion of a purse string suture. Results: Causes of obstruction included failed dacryocystorhinostomy (DCR) (74 cases) and idiopathic obstruction (22 cases). Postoperative complications were encountered in four cases with tube loss, 21 cases with a buried tube, 8 cases of extrusion to the conjunctival side, and 11 cases with obstruction caused by conjunctival incarceration or granuloma. The postoperative success rate was 89.1%. Conclusions: The authors concluded that endoscopic CDCR using MCTD is an alternative to the standard conventional method for preventing dislodgement of the tube postoperatively. However, surgeons should consider that it may be challenging to insert the MCTD and that in cases requiring removal, the tube can be difficult to remove due to adhesions.

Evaluation Of The Effectiveness Of Intra-Operative Mitomycin C For Pterygium Surgery In African Eyes

Aims: This study was designed to evaluate Pterygium surgery and intra-operative mitomycin C application in Warri, Nigeria. Methods: Case files of all patients who had pterygium surgery and intra operative application of 0.4 mg/ml of Mitomycin C; and were followed up for a minimum of 12months at DDS Eye Surgery in Warri, Nigeria between January 1998 – June 2002 were reviewed. Results: One hundred and two eyes (87patients) had pterygium surgery and mitomycin C application intraoperatively. Fifteen eyes (14.7%) had recurrence after a minimum follow up period of 12 months. The male to female ratio was 1.4:1. The mean age of all the patients was 41.6 years. The mean age of the patients with recurrence was 39.6 years while that of the non-recurrence was 43.3 years. Main complications encountered were conjunctival granuloma thirteen (12.8%); delayed healing nine (8.8%); scleral melt three (2.9%). None of the eyes with delayed healing or scleral-melt had recurrence of their pterygium, but four out of thirteen eyes (31%) with conjunctival granuloma had recurrence of their pterygia. Use of native medication (cocktail of herbal extracts) and duration of pterygium before surgery had no bearing on recurrence. Most of the recurrences occurred between the 4th and the 6th months (73.3%). Conclusion: Single intra-operative application of 0.4mg/ml of mitomycin C was found to be effective in reducing the incidence of recurrence of pterygium below 15% (14.7%) in African eyes. Ophthalmologists are advised to give patients the maximum benefit of pterygium surgery by using intra-operative mitomycin C. Keywords: Pterygium recurrence, Post operative complications, Mitomycin CSahel Medical Journal Vol. 10 (4) 2007: pp. 132-136

Mucocutaneous Splendore‐Hoeppli phenomenon

Splendore-Hoeppli phenomenon (asteroid bodies) is the in vivo formation of intensely eosinophilic material (radiate, star-like, asteroid or club-shaped configurations) around microorganisms (fungi, bacteria and parasites) or biologically inert substances. This study presents a literature review concerning Splendore-Hoeppli reaction in the mucocutaneous diseases. It examines the histopathological features, nature and differential diagnosis of this reaction. It also discusses the mucocutaneous infections and the non-infective diseases associated with it. Available studies indicate that several mucocutaneous infections can generate Splendore-Hoeppli reaction. The fungal infections include sporotrichosis, pityrosporum folliculitis, zygomycosis, candidiasis, aspergillosis and blastomycosis. The bacterial infections include botryomycosis, nocardiosis and actinomycosis. The parasitic conditions include orbital pythiosis, strongyloidiasis, schistosomiasis and cutaneous larva migrans. In addition, Splendore-Hoeppli reaction may be seen with non-infective pathology such as hypereosinophilic syndrome and allergic conjunctival granulomas. The Splendore-Hoeppli reaction material comprises antigen-antibody complex, tissue debris and fibrin. Although the exact nature of this reaction is unknown, it is thought to be a localized immunological response to an antigen-antibody precipitate related to fungi, parasites, bacteria or inert materials. The characteristic formation of the peribacterial or perifungal Splendore-Hoeppli reaction probably prevents phagocytosis and intracellular killing of the insulting agent leading to chronicity of infection. To conclude, Splendore-Hoeppli reaction is a tell tale of a spectrum of infections and reactive conditions. The molecular pathways involved in the development of this reaction are open for future investigations.

Atteintes ophtalmologiques de la sarcoïdose et des « sarcoid-like reaction » dans les déficits immunitaires. À propos de 4 cas

Granulomatosis lesions occurring after diagnosis of primary or secondary immunodeficiency are not accidental and have been described in a small number of patients suffering from various diseases: common variable immunodeficiency (CVID), malignancy (lymphoma and solid tumors), and acquired immunodeficiency syndrome (AIDS). Two types of granulomatosis can appear: true sarcoidosis and sarcoid-like reaction. We report four patients, two with CVID and two with malignancy, in whom clinical granulomatosis appeared a few months to a few years after diagnosis of immunodeficiency. They developed noncaseating granulomas of the lung, spleen and liver associated with conjunctival granulomas and bilateral panuveitis. The granulomatous disorder was diagnosed after immunodeficiency on histopathological studies revealing noncaseating granulomas. Causation agents such as infectious organisms and environmental compounds were excluded. The relationship between sarcoid-like reaction, true sarcoidosis and immunodeficiency is discussed. The underlying pathophysiology responsible for the association between granuloma formation and immunodeficiency in the same patient remains obscure. It may be quite difficult to distinguish true sarcoidosis and sarcoid-like reaction. It is possible that these two entities are the clinical extremes of a common pathological process.

Foreign body conjunctival granuloma

Abstract Purpose To present a case of a small inflammatory epibulbar mass developed soon after a branch of the tree injury. Methods 57‐years old healthy men presented to our Department with complaints of discomfort, foreign body sensation, mild tearing and redness of his left eye. The patient sustained branch tree injury two weeks before. Slit lamp examination demonstrated a small red mass measuring about 3mm in diameter, located at the 3 o`clock position, loosely connected with adjacent tissues. An excisional biopsy of the mass was performed and tissue was send to histopathology laboratory for microscopic analysis. Results Microscopic examination revealed a massive infiltrate composed with multiple giant cell (of foreign body type) surrounding organic material (pieces of wood and plants) together with multiple plasma cells and lymphocytes. Focally neutrophils were also present. Histopathology diagnosis: foreign body conjunctival granuloma. Clinical differential diagnosis should considered: conjunctival benign lesions, Splendore‐Hoeppli fenomenon, inclusion conjunctival cyst or nodular episcleritis. Conclusion 1.Foreign body granuloma should be considered in differential diagnosis of conjunctival epibulbar lesions. 2.Histopathology is crucial for proper and final diagnosis.