Carbon dioxide laser-induced combustion of extravasated intraocular silicone oil in the eyelid mimicking xanthelasma

Silicone Granulomas of the Eyelids-A Case Series Illustrating a Distant Migratory Phenomenon

PURPOSE

Exogenous silicone has been reported to migrate to anatomic sights far from an initial injection or implantation site; this phenomenon has been rarely described in the ocular adnexa, especially in the eyelids. We document 3 additional cases of distant migration of silicone implanted elsewhere in the body to the eyelids and review the prior literature on this uncommon event.

METHODS

A retrospective chart review of 3 patients was conducted along with analysis of diagnostic histopathology. A comprehensive review of the literature regarding dissemination or migration of silicone to the eyelids in patients with either silicone breast implants or silicone facial filler use was performed.

RESULTS

Cases of silicone migrating to the eyelids from silicone breast implants and silicone-based facial filler are outlined in Tables 1 and 2, respectively. There are 4 total reports of women with silicone breast implants, including the 2 described here, with evidence of migration of silicone to the eyelid. Similarly, 5 cases of silicone-based facial filler with resultant migration of filler to the eyelids were identified, including 2 of the cases presented in this report (1 patient had both silicone breast implants and silicone facial filler).

CONCLUSION

Silicone is chemically inert, but is known to travel throughout the body, causing a resultant foreign body response in tissue that can adversely affect even the eyelids. Silicone has a relatively characteristic histologic appearance and diagnosis of silicone granuloma highlights the importance of obtaining a thorough clinical history, particularly regarding prior cosmetic injections or breast enhancement surgery. Foreign material/foreign body granuloma is important to consider in patients with deep eyelid nodules of unclear etiology.

Orbital and periorbital migration of silicone oil associated with emphysema development after retinal detachment repair - Case report and literature review

Purpose

To report a very rare case of silicone oil (SO) migration and emphysema development in the orbit and periorbital tissue, including the lids and subconjunctival space, after a fourth pars plana vitrectomy (PPV) for retinal detachment (RD) treatment.

Observations

A 53-year-old woman with a recurrent rhegmatogenous RD in the right eye underwent a fourth PPV under local anesthesia and 23-gauge vitrectomy with fluid-air exchange and SO injection. Localized choroidal detachment occurred during fluid–air exchange near the end of the surgery. High-pressure infusion of air was used as a temporary control measure prior to SO injection. In the early postoperative period, the patient developed hemifacial and periorbital swelling and the air trapped in the upper lid was associated with lid ptosis and conjunctival chemosis. The emphysema resolved with clinical management, and the mechanical ptosis subsided after partial SO removal from the lid.

Conclusions and Importance

The SO migration and emphysema in our case were presumably related to the multiple previous sclerotomies. Periorbital emphysema can show spontaneous resolution, but the migrated SO requires surgical management.

Orbital Leakage of Intraocular Silicone Oil: Case Reports and Literature Review

Silicone oil migration into the periorbital tissues occurs rarely after vitreo-retinal surgery and two cases are reported. The first case was a 48-year-old woman who presented with a blind painful right eye, upper eyelid swelling, and ptosis after multiple vitreo-retinal surgeries. Diffuse infiltration of silicone oil in the upper eyelid and anterior orbit was found during evisceration, mainly around the plate of a Baerveldt glaucoma valve. In the second case, a 69-year-old man with prior right scleral rupture underwent silicone oil tamponade for retinal detachment and presented with right upper eyelid swelling due to multiple silicone oil granulomas within the orbit. Open globe injury and glaucoma drainage devices both appear to facilitate extraocular migration of silicone oil that results in marked orbital infiltration and inflammatory response.

Extraocular silicone oil migration to orbit and retrolaminar region: case report and systematic review

BACKGROUND

Silicone oil insertion is a common modality in vitreoretinal surgeries. The purpose of this study is to conduct a systematic review to summarize the uncommon complication of extraocular silicone oil migration.

METHODS

Following the PRISMA guidelines, a systematic review of the literature was performed on January 11, 2020, using PubMed and EMBASE with the following terms: "silicone oil," "eye," and "migrat*."

RESULTS

A total of 69 patients-68 patients from 59 articles and one case from our institution-were included in the final analysis. The median age was 54 years (range, 9-92) and 40 patients (57.9%) were men. Orbital migration was reported in 34 patients, and retrolaminar migration (including optic nerve, optic chiasm, suprasellar, subarachnoid space, intraventricular spaces) was reported in 35 patients. Orbital migration group had more aphakics (p = 0.007), implanted glaucoma drainage device (p = 0.005), scleral buckle (p = 0.000), history of trauma-related indications for pars plana vitrectomy (p = 0.000), shorter silicone oil endotamponade time (p = 0.008), more symptomatic (p = 0.000), and requiring surgical intervention (p = 0.000). Retrolaminar migration group had older patients (p = 0.016) and more diabetics (p = 0.041).

CONCLUSION

Systematic review sheds light on plausible risk factors on site of silicone oil migration. Majority of orbital cases are symptomatic and require intervention while retrolaminar cases are incidental and can be managed conservatively. Awareness of this complication can help guide clinicians predict which patients would likely need surgical intervention. Graphical abstract.

Granulomatous reaction to migrating silicone oil clinically mimicking a xanthelasma: A case report

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Distant silicone oil migration may occur following retina surgery.

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Silicone oil in periocular tissue results in granulomatous reaction.

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It may resemble a periocular xanthelasma-like skin lesion.

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Tissue diagnosis is essential for confirmation in such cases.

Introduction

Silicone oil has been used for many years in retinal surgeries for retinal detachment. One of its reported complications is oil migration to the periorbital area, resulting in granulomatous reaction.

Presentation of case

A 56-year-old lady, with history of retinal detachment that was repaired by vitrectomy, silicone oil removal and epi-retinal membrane peeling, presented to us with unilateral ptosis and a skin lesion that resembled xanthelasma.

Discussion

Histopathology of this lesion showed silicone oil infiltrating the surrounding connective tissue and fat with absence of foamy histiocytes.

Conclusion

We are reporting a case of silicone oil migration with pseudo-xanthelasma lesion. This has been reported only twice to the best of our knowledge in the English-written literature.

Orbital, eyelid, and nasopharyngeal silicone oil granuloma presenting as ptosis & pseudo-xanthelasma

PURPOSE

To highlight the presentation and management of a patient with eyelid, orbital and nasopharyngeal silicone oil migration through a glaucoma drainage implant presenting as pseudo-xanthelasma and ptosis.

OBSERVATIONS

A 68-year male presented with unilateral ptosis and presumed xanthelasma. He had a history of glaucoma drainage implant surgery, pseudophakia, and multiple retinal detachment repairs with silicone oil. During ptosis repair it was discovered that his presumed xanthelasma was in fact an eyelid silicone granuloma. Additional work up revealed silicone infiltration of the eyelids, orbits, and nasopharynx, resulting from emulsified silicone oil leakage through his glaucoma valve implant.

CONCLUSIONS AND IMPORTANCE

Silicone oil may emulsify with time, with potential egress via a glaucoma filtration device. Clinicians should be alert for eyelid, orbital and sinonasal findings that may indicate occult migration.

Xanthelasma palpebrarum - a brief review

Xanthelasma palpebrarum is the most common cutaneous xanthoma, characterized by yellowish plaques over eyelids – most commonly, over the inner canthus of the upper lid. It is triggered by hyperlipidemia, thyroid dysfunction, and diabetes mellitus. Xanthelasma results from perivascular infiltration of mono- and multinucleated foam cells within lipid-laden cytoplasmic vacuoles in the superficial reticular dermis. Different modalities of treatment, such as simple surgical excision, cryotherapy, chemical peeling with trichloroacetic acid, radiofrequency, and laser, are used in the treatment of xanthelasma palpebrarum. A brief review of current treatment strategies is presented here.