Periorbital Mass Research Articles

Ocular manifestations of granulomatosis with polyangiitis: report from a tertiary eye care center.

To report demographic characteristics and ophthalmological manifestations of patients with granulomatosis with polyangiitis (GPA) in a tertiary eye care center in Turkey. Medical records of patients with GPA-related ocular manifestations evaluated between 2013 and 2023 were included. Demographic and clinical characteristics of the patients including nature of systemic involvement, ophthalmologic symptoms and signs, laboratory investigations and treatment modality were reviewed. Twelve eyes of 10 patients (5 female/5 male) were included. The mean age was 57.2 ± 12.2 (35-71) years. Five (50%) patients were already diagnosed with GPA. Ocular involvement was the first manifestation of GPA in 3 patients. The remaining 2 patients had simultaneous systemic and ocular symptoms at presentation. Conjunctival hyperemia (9 eyes) and pain (7 eyes) were the most frequent presenting symptoms followed by blurred vision (3 eyes). The frequencies of ocular manifestations were as follows:episcleritis (3 eyes), isolated peripheral ulcerative keratitis (PUK) (3 eyes), scleritis (3 eyes), simultaneous PUK and scleritis (2 eyes) and periorbital mass (1 eye). Ophthalmological manifestations can be the initial findings in GPA. Since GPA can affect different structures of the eye, it sometimes might be challenging for ophthalmologists. Therefore, it is crucial for ophthalmologists to be well-informed about GPA-related ocular findings and to have a high index of suspicion for GPA. Although PUK associated with scleritis is highly suggestive for GPA, isolated cases of PUK or scleritis can be seen in GPA. Therefore, it is important to adopt a multidisciplinary approach, consider GPA in differential diagnosis, and benefit from accurate diagnostic tests.

Photo Quiz Answer: Orbital Apex Mass: First, Do No Harm.

The answer is Aspergillus fumigatus periorbital mass. Upon review of the histopathology, Aspergillus and Fusarium were considered the most likely possible diagnoses. Due to variable susceptibility of Fusarium to azoles, empirical liposomal amphotericin (i.v., 5 mg/kg daily) was started. Formalin-fixed tissue was sent for broad-range fungal PCR (1). MRI 6 days after the start of amphotericin showed minimal change, and symptoms were similar. Further surgical intervention to provide any modicum of source control was not deemed feasible without enucleation of the left eye. Aspergillus fumigatus was detected with 28S, internal transcribed spacer, and nested internal transcribed spacer primer sets. Treatment was transitioned to voriconazole. Periorbital swelling began to improve, and the patient was discharged 13 days after surgery. At that time, his vision, ptosis (inability to open his eye at all), and proptosis were unchanged.

Periorbital Mass in a 2-month-old Girl.

Periorbital Mass in a 2-month-old Girl.

Periorbital lipogranuloma after facial injection of autologous fat: A retrospective study of 18 cases.

To investigate the clinical features of patients who develop periorbital lipogranuloma after injection of autologous fat. This retrospective case series included 18 patients who developed a periorbital mass or swelling after undergoing injection of autologous fat for facial augmentation. The patients' medical records were reviewed for clinical history, radiologic findings, and treatment outcomes. All patients were women aged 24 to 50 years (mean, 31.6 years). Five patients (27.8%) involved both orbits. Presenting eye symptoms were a palpable mass (61.1%), eyelid swelling (44.4%), and ptosis (16.7%). The interval between the final injection and onset of eye symptoms ranged from 1 to 36 months (mean, 11.5 months). Thirteen patients underwent radiologic imaging. Fifteen patients received only one injection of autologous fat and three received two injections with the cryopreserved fat used in the second injection. Surgical excision was performed in 12 patients to remove the mass and identify the pathologic abnormalities. No recurrence was found during 1 year of follow-up. Two of the six patients who had refused treatment showed spontaneous resolution at the 6-month visit. Periorbital lipogranuloma after facial injection of autologous fat should be considered as a specific orbital disease entity for which MRI is an effective examination method. Surgery is warranted for this condition when conservative treatment is ineffective.

Whale tear glands in the bowhead and the beluga whales: Source and function.

Orbital glands are found in many tetrapod vertebrates, and are usually separate structures, consisting of individual glands lying in the eyelids and both canthi of the orbit. In cetaceans, however, the orbital glandular units are less distinct and have been described by numerous authors as a single, periorbital mass. There are few histochemical and immunhistochemical studies to date of these structures. In this study, we examined the orbital glandular region of both the bowhead whale (Balaena mysticetus: Mysticeti) and the beluga whale (Delphinapterus leucas: Odontoceti) using histological, histochemical, and immunohistochemical techniques. Histologically, in the bowhead, three glandular areas were noted (circumorbital, including Harderian and lacrimal poles), palpebral (midway in the lower eyelid), and rim (near the edge of the eyelid). In the beluga, there was only a large, continuous mass within the eyelid itself. Histochemical investigation suggests neither sexual dimorphism nor age-related differences, but both whales had two cell types freely intermingling with each other in all glandular masses. Large cells (cell type 1) were distended by four histochemically distinct intracellular secretory granules. Smaller cells (cell type 2) were not distended (fewer granules) and had two to three histochemically distinct intracellular secretory granules. The beluga orbital glands had additional lipid granules in cell type 1. Counterintuitively, both lipocalin and transferrin were localized to cell type 2 only. This intermingling of cell types is unusual for vertebrates in whom individual orbital glands usually have one cell type with one to two different secretory granules present. The heterogeneity of the orbital fluid produced by cetacean orbital glands implies a complex function, or series of functions, for these orbital glands and their role in producing the tear fluid.

Clinical analysis of adult onset orbital xanthogranuloma

Objective: To investigate the clinical, imaging and pathological features of adult onset xanthogranuloma. Methods: Retrospective case series study.The clinical data of 4 adult patients with adult onset xanthogranuloma treated in the Tianjin Medical University Eye Hospital from 2015 to 2017 were analyzed. Results: There were 1 male and 3 females, aged 46-73 years, with an average age of 55 years. The duration of eyelid swelling was from 6 months to 6 years. One case was binocular and 3 cases were monocular. There were progressive enlargement of eyelid swelling and subcutaneous cord nodules with poor mobility and no tenderness in all 5 eyes. The eyelid skin in 2 patients (2 eyes) was bulging and yellow. CT examination showed swelling of the eyelids and soft tissue thickening in 5 eyes. There were lacrimal gland enlargement in 3 eyes, upper rectus muscle involvement in 3 eyes, external rectus muscle involvement in 1 eye, lower rectus muscle involvement in 1 eye, superior oblique muscle involvement in 1 eye, and involvement of both the superior and inferior rectus muscles in 1 eye. In 1 patient (1 eye), the lesion showed low and medium signals on T(1) weighted images and T(2) weighted images. Three patients (4 eyes) underwent color Doppler ultrasonography, showing the echo zone in the irregularly shaped eyelid was strong, the internal echo was uneven, the local echo was low, and the boundary was not clear. One of the eyes showed a blood flow signal. All patients underwent surgical resection. The pathological results showed infiltration of foamy tissue cells, Touton cells, lymphocytes and plasma cells. Immunohistochemistry demonstrated 3 patients (4 eyes) expressed CD68, and 1 patient (1 eye) expressed S-100. After 6 months to 2 years of follow-up, 3 patients had no recurrence. One patient developed eye discomfort at 6 months after surgery, and the symptoms were relieved after treatment with triamcinolone. Conclusions: Adult onset xanthogranuloma mainly manifest as eyelid swelling, periorbital mass and skin color changes, generally with no systemic involvement. Imaging examination mainly shows the involvement of soft tissues, lacrimal glands and muscles around the eyelids. The main features of the pathology are infiltration of foamy tissue cells, Touton giant cells, lymphocytes and plasma cells. (Chin J Ophthalmol, 2019, 55: 381-386).

A rapidly growing periorbital mass: pilomatrixoma.

Purpose: To report a case of pilomatrixoma that presented as a periorbital area painful, perforating, rapidly growing mass. Case summary: A 35-year-old man presented with rapidly growing a left lower periorbital mass 5 months duration. On examination, it measured 13 mm sized and it was located at the lateral side of the left lower periorbital area. The mass was accompanied with pain. A perforation with yellowish crust on the left lower periorbital area was observed. Conclusion: In patients presenting with a painful and perforating mass, the pilomatrixoma should be considered as a differential diagnosis of a solitary periorbital mass.

Clinical characteristics of patients with a periorbital mass after autologous fat injection for facial augmentation and short-term outcomes of steroid treatment

The aim of this study was to evaluate the clinical features of patients with a periorbital palpable mass or swelling after autologous fat injection for facial augmentation. This retrospective case study included 50 patients who developed a periorbital palpable mass or swelling after undergoing autologous fat injection for facial augmentation performed by various plastic surgeons. The patients' medical records were reviewed for clinical history, radiological findings, and treatment outcomes. All patients were female with a mean age of 43.18±12.04 (range, 19-63) years. After fat injection, the average time of symptom onset was 9.09±8.45 (1-36) months, and the mean follow-up duration was 13±1 (4-36) weeks. Majority of patients complained of eyelid swelling or periorbital palpable mass. All patients had received fat injection in the forehead area, except for the following patients: Five patients who were unaware of the site of fat injection and one patient who had received the injection in the upper eyelid area with simultaneous double-fold surgery. In addition, 39 patients had received a second injection of cryopreserved autologous fat tissue. Forty-five patients developed a mass in the upper eyelid area, four were found to have the mass in the lower eyelid area, and one patient developed the mass in both eyelids. Computed tomography and magnetic resonance imaging revealed isolated fat tissue, periorbital inflammation, or a soft tissue mass with fat density. Oral steroids were used to treat 41 (82.0%) patients; 31 (75.6%) showed satisfactory outcomes, nine (22.0%) patients did not return to the clinic after the first oral steroid treatment, and the periorbital mass persisted in one patient (2%) even after the oral steroid treatment. The patient with the periorbital mass underwent surgical removal and tissue biopsy. Asymptomatic patients (eight; 16%) underwent observation without treatment. As a first treatment, one patient (2%) requested an immediate surgical removal of the periorbital mass. Therefore, surgical excision and biopsy were performed in two patients (4%). During surgery, a granulomatous mass was found in the preseptal region, with liquefied necrotic fat flowing out. Histological examination revealed a lipogranuloma with granulomatous inflammation. Clinicians should confirm a history of autologous fat injection and be aware of the clinical features in patients who present with a periorbital palpable mass or swelling. Oral steroid therapy should be considered before surgery because it may prove to be effective. Further studies with long-term follow-up periods are necessary.

A Case of Chronic Osteomyelitis of the Orbit

Purpose: To report a case of chronic osteomyelitis of the orbit. Case summary: A 61-year-old woman visited the ophthalmology clinic with a 3-month history of right periorbital swelling and pain. She had a history of ondontitis treated with oral antibiotics three months previously. A hard, tender, swollen mass was palpated near the right lower eyelid extending to the floor of the right orbit. Otherwise, there were no other clinically-specific ocular signs. Orbital computed tomography and bone scan findings suggested right periorbital soft tissue inflammation with underlying osteomyelitis of maxillar and zygomatic bones involving the inferior and lateral orbital walls. The patient was admitted and treated with broad spectrum systemic antibiotics. After 7 days, periorbital soft tissue swelling and pain were improved, but the size of the hard mass was unchanged. Seven days after admission, incision and drainage of the periorbital hard mass near the lower eyelid and debridement of the necrotic and pyogenic tissue were performed. Histologic examination showed chronic granulomatous inflammation and bony necrosis of the mass. The patient was discharged after receiving systemic antibiotics for 7 more days. At the 6-month follow-up, no recurrence or abnormal findings in the right periorbital region were observed. Conclusions: Chronic orbital osteomyelitis should be treated with combined systemic antibiotics and surgical intervention. J Korean Ophthalmol Soc 2014;55(6):902-907

Periorbital nodular fasciitis arising during pregnancy

Nodular fasciitis (NF) is a benign proliferation of fibroblasts and myofibroblasts that rarely occurs in the periorbital region. We report what we believe to be the first case of periorbital NF associated with pregnancy. A case of intravascular fasciitis, a NF variant, has been reported during pregnancy, but it was not located in the periorbital region. A weak presence of estrogen receptors has been reported in NF. This may make it more susceptible to the hormone-related changes during pregnancy and contribute to the development of the lesion by stimulating fibroblasts and smooth muscle cell types. Although rare, NF should be considered in the differential diagnosis of periorbital soft-tissue masses arising during pregnancy.

Pilomatrixoma in a patient with bilateral retinoblastoma

A 3-year-old girl with a history of bilateral retinoblastoma presented with a new right lower periorbital mass that showed calcifications on ultrasound. She had previously undergone systemic and intra-arterial chemotherapy for retinoblastoma but had no evidence of active disease for at least 6 months previously. Her family and oncologists feared that this mass was an extraocular metastasis of her retinoblastoma. On excision, it was diagnosed as a pilomatrixoma, an uncommon benign neoplasm that originates from the matrix of the hair root. This is the first reported case of pilomatrixoma ina patient with retinoblastoma.

Reconstructive Complications After Perioculer Mass Excision

This study includes 6 interesting cases who developed complications after reconstructive surgery due to periorbital mass excision. Patients' data were evaluated retrospectively. Three patients with different ages,who developed ecchymoses postoperatively, were followed up.The first patient was 17 years old and dermoid cyst excision was performed on the lateral side of orbita at the eye brow level. This patient did not have any systemic disease and was simply followed up.Other two patients were at advanced age and both of them developed ecchymoses bilaterally..Another patient was also at advanced age and developed necrosis following reconstruction with skin flap. In this case, by graft application complete healing was succeeded uneventfully.. Two other cases drew attention due to scar development after primary suturation. According to the degree of scar formation, surgery or follow up was performed.Complications could be seen even after well planned and performed periocular reconstructions.Close follow up and abrupt treatment are essential.

CT and MR Imaging Findings of Periorbital Lipogranuloma Developing after Endoscopic Sinus Surgery

Periorbital lipogranuloma is a rare complication after ESS and presently lacks specific imaging reports. The purpose of this study was to describe the CT and MR imaging features of periorbital lipogranuloma. We retrospectively reviewed 9 patients with histology-confirmed periorbital lipogranuloma. All 9 patients underwent CT and MR imaging. Five lipogranulomas were located in the right eyelid and 4 in the left eyelid, which extended into the extraconal space to some degree. The lesions displayed an irregular shape and had an ill-defined margin. Multiple, specked, or nodular foci containing fat were scattered within these lesions. The lesions demonstrated moderate heterogeneous contrast enhancement on contrast-enhanced MR imaging. The TICs showed a persistent pattern (type I) in 6 patients undergoing DCE MR imaging. Thus, an ill-defined, irregular-shaped periorbital mass with multiple foci containing fat, combined with an ESS history, can help to accurately diagnose this entity.

Colour Doppler ultrasound imaging findings in paediatric periocular and orbital haemangiomas

To evaluate the combined grey-scale ultrasonography (US) and colour Doppler imaging (CDI) as the first and primary imaging modalities in diagnosing paediatric orbital haemangiomas. The charts of 20 consecutive children with a periorbital mass echographically diagnosed as a haemangioma between January 2004 and June 2009 in the Tel-Aviv Sourasky Medical Center were reviewed. Data on demographic details, clinical findings, US and CDI characteristics, treatment and outcome were retrieved. Twelve (60%) haemangiomas were located on the upper eyelid, five in the lower eyelid (25%) and three in the medial cantus (15%). The tumour resolved completely in 10 children (50%) and in 10 children (50%) partial resolution was documented. Seven (35%) patients underwent treatment (intralesional or oral steroids or propranolol). Grey-scale US depicted a solid-tissue mass with low internal echogenicity. Mean haemangioma volume was 1.33 cm(3) . Colour Doppler imaging demonstrated intralesional flow with a mean peak systolic velocity of 15.2 cm per second and a mean resistance index of 0.51. All US and CDI examinations were carried out on alert children and no sedation or general anaesthesia was needed. During mean follow-up time of 23 months, no child required any additional imaging or diagnostic procedures to confirm the diagnosis. Combined US and CDI are suggested as the first imaging modalities in cases with a suspected diagnosis of periocular and orbital capillary haemangioma.

Orbital dermoid cyst with sinus tract mimicking ectopic cilia

Dermoid cysts are the most common periorbital masses presenting in childhood. We describe an unusual case of a dermoid cyst presenting with black hairs emerging from a sinus tract on the upper eyelid and mimicking the appearance of ectopic cilia. Our case highlights the value of radiologic examinations in such cases.

Metastatic Esophageal Squamous Cell Carcinoma to the Orbit and Periorbit Masquerading as Periorbital Abscess

A 61-year-old man with no history of malignancy presented with a rapidly expanding left periorbital mass, first noticed one month prior to presentation. The mass was firm, and a pus-like discharge drained spontaneously from the center of the lesion. A biopsy was performed, and histopathology confirmed squamous cell carcinoma. Systemic evaluation revealed that the patient had a primary esophageal squamous cell carcinoma with multiple metastases. The prognosis of orbital metastasis is generally poor, and this patient expired after one month of conservative treatment.

Periorbital Tuberculosis in a Young Man: A Case Report

Background: Tuberculosis is an endemic disease in developing countries which may involve various organs. Soft tissue involvement including periorbital tissues is very rare, and often this involvement is accompanied by the involvement of other body organs such as lungs. Most of the patients suffering from periorbital infections have underlying diseases and diagnosis of these infections without concomitant involvement of other parts of body is often complex. Case presentation: In this paper, a periorbital tuberculous infection is described. A 17-year-old male with chronic periorbital mass underwent surgical and medical treatment and the mass recurred. Culture and microscopic studies of the specimen showed mycobacterium tuberculosis. The patient was treated for a periorbital tuberculous infection for a 6-month period with antituberculous regimen and was cured. Conclusion: Periorbital tuberculous infection may occur in the absence of underlying factors or active tuberculosis in the rest of the body organs or a history of tuberculosis infection.

Case 103: PHACE Syndrome

History A 10-month-old girl had an enlarging, warm, reddish left periorbital cutaneous and subcutaneous mass since infancy. Her medical history was otherwise unremarkable. Magnetic resonance (MR) imaging of the brain was performed.

Ocular Adnexal Pseudo-Cyst Formation as a Characteristic Feature of Perineural Spread in Squamous Cell Carcinoma

To report the clinical features in a series of patients with perineural spread of squamous cell carcinoma involving periorbital nerves that presented with clinical and/or imaging evidence of pseudo-cystic transformation along the involved nerves. A noncomparative, retrospective chart review of the clinical and imaging findings of patients attending a regional orbital surgery department between 1998 and 2005, presenting with a pseudo-cystic orbital mass on clinical examination and/or imaging, which proved to be due to perineural squamous cell carcinoma on histopathology. The study included 8 male patients with a mean age at referral of 66 +/- 11 years. All cases had associated cutaneous squamous cell carcinoma involving the face or scalp, and, in 4 cases, the primary tumor could be identified in the vicinity of the affected orbit. The duration of the symptoms varied from 5 weeks to 9 years (24 +/- 36 months). Altered sensation, including formication and hypo-esthesia in the V1 and V2 trigeminal division, motor nerve palsies, and ptosis in conjunction with a palpable periorbital mass, were the most common presentations. The cystic tumor deposits were assessed histologically with both hematoxylin and eosin and immunoperoxidase stains (S100 protein for neural structures identification and MNF116 as a keratin marker). This demonstrated malignant squamous epithelium both within and around the wall of the tumor deposit and, in continuity, within the nerve running through the lesion. Some nerves showed substantial areas of fibrosis, representing obliteration of the nerve structure caused by involvement by tumor. Treatment modalities included surgical debulking, exenteration, radiotherapy, and combined chemo-radiotherapy. Mean follow-up was 29 +/- 23 months. Eight patients (87.5%) remain alive, and five of them show no evidence of disease. One patient died after progression of the malignancy. The presence of a cystic lesion in association with sensory or motor deficit in the periorbital region should suggest a diagnosis of perineural spread from a cutaneous squamous cell carcinoma. Because these patients may present to the ophthalmologist first, an awareness of this entity is of critical importance to avoid the delayed diagnosis seen in half of our cases.

Periocular Subperiosteal Deep Granuloma Annulare in a Child

A 2-year-old child presented with a painless subperiosteal periorbital mass of 6 months' duration. This was associated with several small cutaneous nodules that resolved spontaneously before surgical excision of the orbital lesion. Excisional biopsy of the lesion revealed a deep granuloma annulare in a subperiosteal location along the superior orbital rim. The patient did well after surgery, with no evidence of recurrence after 18 months. Deep granuloma annulare is a rare lesion often confused with rheumatoid nodule. It has not previously been reported in a subperiosteal location around the orbit. Although granuloma annulare is typically benign and often self-limiting, in some cases it can be associated with systemic disease.