Early results of surgical management of conjunctival dermolipoma: partial excision and free conjunctival autograft

A retrospective study of conjunctival lesions in the Paediatric Eye Clinic over 12 years

BACKGROUND

Paediatric conjunctival lesions are rare and diverse. Though often indolent and asymptomatic, they can in some cases be sight or life-threatening. Awareness of concerning features of conjunctival lesions is key to optimal management. We aim to provide insight into management of paediatric conjunctival lesions though a review of cases in our service in last 12 years.

METHODS

We present a retrospective analysis of our population-based cohort of children with conjunctival lesions presenting to our regional service in Belfast between 2011 and 2022 inclusive. We detail three rare cases of paediatric conjunctival lesions; a congenital intrascleral cyst leading to astigmatic amblyopia, a rapidly changing salmon-pink lesion confirmed as an embryonal rhabdomyosarcoma and an unusual presentation of a chronic granuloma arising from the caruncle.

RESULTS

85 conjunctival lesions were identified in <16 year olds giving a cumulative incidence of 27 cases per 100,000 population over 12 years. Mean age at presentation was 7 years old. Most common lesions were naevi (40%), limbal dermoids (21%), conjunctival melanosis (14%), conjunctival cysts (7%) and phlycten (6%). When seen at presentation 8% of cases were immediately listed for surgery, 28% were discharged and 64% entered a phase of observation.

CONCLUSION

Paediatric conjunctival lesions have potential to cause visual manifestations, whilst some may undergo malignant transformation. Anterior segment photography is crucial in monitoring change and facilitating early discharge in the absence of sinister features. Malignant transformation must be considered in changing lesions which ought to have histological diagnosis obtained to prevent potentially sight and life-threatening conditions.

Dermolipoma in an Unusual Location: A Case Report and Literature Review

A healthy nine-year-old Japanese male presented with a history of inferonasal conjunctival mass that was noted to increase in size in a few years' time. Initial examination revealed a 10-mm soft yellowish inferonasal conjunctival mass with a whitish surface. The rest of the examination findings were unremarkable. A computed tomographic scan was done and showed a conjunctival mass that was not connected posteriorly to the orbital fat but had the same density as the orbital fat. Complete surgical excision was performed, and pathologic evaluation of the excised specimen revealed a dermolipoma. The patient was subsequently followed up to monitor for any postoperative complications. Three months following the operation, there was no recurrence of the tumor, and the patient had an excellent cosmetic outcome.

Bilateral Epibulbar Dermolipomas in a Patient With Goldenhar Syndrome

ABSTRACT

A 19-year-old woman consulted for bilateral superotemporal conjunctival lesions that had been present since birth. Physical examination also revealed hemifacial microsomia and bilateral auricular appendages. Medical history included heart, hearing, and neurologic problems. Excision biopsy of these lesions showed nodular proliferations of adipose tissue, which corresponded to the diagnosis of dermolipomas in the setting of Goldenhar syndrome. Complete examination for other first and second branchial arch anomalies is warranted in patients presenting with such lesions.

The Presentation and Surgical Treatment of Peribulbar Dermolipomas

PURPOSE

To evaluate the presentation, treatment, and outcome for patients with peribulbar dermolipomas and describe a reliable technique for excision of large lesions.

PATIENTS AND METHODS

Retrospective chart review for patients seen at Moorfields Eye Hospital between 1976 and 2019. Patient demographics, clinical features, imaging (CT or MRI, where available), histopathology, and surgical outcomes were reviewed.

RESULTS

One hundred and ninety-six eyes of 187 patients (117 females; 63%) were identified as having dermolipoma, the patients presenting at an average age of 21.5 years and-where recorded in 163 patients-had first symptoms at an average age of 12.9 years. Although 8/187 (4%) patients were asymptomatic, the commonest symptom was increasing size of a longstanding peribulbar lump (136 patients; 73%); other symptoms included ocular irritation (24%), episodic localized conjunctival injection (12%), and mucoid discharge (12%). One-third of dermolipomas had visible hairs (some with localized giant papillary conjunctivitis), lateral canthal widening was present in 44 patients, aberrant lacrimal gland ductules opening onto skin in 8, and a complex lateral canthal anomaly-with both an external dermoid and an internal dermolipoma-was present in 9 patients. Complete management details were available for 120 patients (those treated after 1990) and 40 (33%) electing for observation, 71 (59%) had excision for long-term irritation and discharge and 9 (8%) for cosmesis: together with the integral subdermal fat lobule, in all cases the abnormal, nonwetting squamous epithelium was delineated and excised under microscopic control, and the conjunctival defect closed directly (59/80 eyes) or with a "V-to-Y" closure (21 eyes; 26%). The presenting symptoms were cured in all except 1 patient, who required excision of residual abnormal epithelium causing persistent symptoms. Two patients developed symblepharon to the lateral canthus after direct conjunctival closure, this having no functional effect, and 2 other patients had slight restriction of extreme horizontal gaze.

CONCLUSION

Dermolipomas may require surgery when they become more prominent with age, or start causing ocular irritation and discharge. Complications are few with meticulous removal of the nonwetting squamous epithelium and direct conjunctival closure, or when using a "V-to-Y" conjunctivoplasty for larger defects.

An Unusual Presentation of Conjunctival Dermolipoma With a Skin Tag

Dermolipoma is considered the second most common benign conjunctival tumor in children after nevus. Usually, dermolipoma located just deep in the superotemporal bulbar and forniceal conjunctiva. The authors describe an uncommon presentation of dermolipoma that arise in the conjunctiva as well as in the skin of the lateral canthus. A 5-month-old baby with lateral limbal lesion involving the conjunctiva and the skin underwent excision biopsy. The pathological examination found a dermolipoma in the conjunctiva as well as in the dermis. The outcomes of the excision were satisfactorily functional and cosmetic.This is only the second case of dermolipoma in the dermis in normal baby that described those far in the literature. This case should raise the awareness that dermolipoma should be considered in differential diagnosis of lesions of the lateral cantus and the periocular skins near it.