Pyogenic granulomas of the cornea

Pyogenic granulomas are vasoproliferative, inflammatory lesions composed of granulation tissue, which occur on cutaneous or mucosal tissues, often arising secondary to other processes such as trauma or infection. Conjunctival pyogenic granulomas are not rare, but corneal involvement is very unusual and can occasionally lead to problems in the differential diagnosis of corneal masses. We report three cases of pyogenic granuloma involving the cornea. The clinicopathologic features of these cases and a review of the literature on the ocular manifestations of this condition are presented.     

Pyogenic granulomas after silicone punctal plugs: a clinical and histopathologic study

PURPOSE: To describe clinical findings, histopathologic changes, and risk factors for pyogenic granuloma formation complicating silicone punctal plug therapy. DESIGN: Retrospective observational case series. METHODS: Between November 2000 and April 2004, 903 silicone punctal plugs of the same brand were inserted in 404 subjects. Cases associated with pyogenic granuloma formation were identified and reviewed. Granulation tissue was obtained from 10 patients for histopathologic examination. Multiple risk regression analyses identified factors related to pyogenic granuloma development and factors associated with histologic patterns. RESULTS: Pyogenic granuloma development led to the extrusion of 4.2% of all plugs placed in a median time period of 141 days. All patients presented with varying degrees of plug extrusion. Similar distributions of partial and complete plug extrusions, as well as bilateral and unilateral plug extrusions, were seen. Findings at presentation ranged from a subclinical pyogenic granuloma causing partial plug extrusion to a pyogenic granuloma in the punctum with a ring of fibrovascular tissue retaining a completely extruded plug. Histopathologic examination revealed two patterns, representing either acute pyogenic granuloma or involuting pyogenic granuloma. Pyogenic granulomas resolved after 3.1 +/- 1.3 weeks in all patients after plug removal. Multiple regression analysis revealed that large plug size was associated with increased pyogenic granuloma formation (P < .0001). Partial or complete plug extrusion was associated with active or involuting pyogenic granuloma, respectively (P = .023). CONCLUSION: Pyogenic granuloma-related spontaneous plug extrusions may be more common than previously thought and can present with a range of clinical findings. The degree of plug extrusion correlates with the histopathologic pattern. Larger plug size and sharp edges in plug geometry may be responsible for pyogenic granuloma formation.     

Pyogenic granuloma

A retrospective review of cases of pyogenic granuloma seen at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between 1984–1991 is described. Epidemiology and the factors that led to the granuloma formation were examined and only cases documented histopathologically were included in the review. Of the 110 cases, 80% developed the granuloma at the site of the previous surgery (especially entropion repair, and dacryocystorhinostomy with a stent tube or with a Jones tube) while 20% did not have a prior surgery. Recurrence occurred in 7% and these patients were in the group who had a prior surgery. Surgical procedures lead to an increased tendency for the formation of pyogenic granuloma due to different mechanisms acting via a mechanical or chemical irritation and an inhibition of re-epithelialization.     

Pyogenic granuloma of the cornea

Background: Ocular pyogenic granulomata are uncommon and are often associated with a chalazion or previous ocular and adnexal surgery. The avascular nature of the cornea may explain the rarity of pyogenic granulomata at this site. We report on a case of corneal pyogenic granuloma following previous corneal surgery.
Methods: Ophthalmologists who had treated the patient previously were contacted and earlier clinical notes and histopathological examinations were reviewed. The clinical course following excision of the pyogenic granuloma is described, as are the histopathological findings.
Results: Histological examination confirmed the diagnosis of pyogenic granuloma. Excision was followed by a clinical recurrence at a different site with spontaneous resolution.
Conclusions: Pyogenic granulomata of the cornea are rare. However, the present case illustrates the importance of considering benign inflammatory causes in the differential diagnosis of a corneal mass lesion so as to avoid unnecessarily aggressive intervention. To our knowledge, spontaneous resolution of a corneal pyogenic granuloma has not been previously described.     

Idiopathic conjunctival granulomas.

A 12-year-old white boy presented with a 1-year history of intermittent bilateral follicular conjunctivitis with yellowish bulbar and limbal nodules and few symptoms. Histopathological examination of conjunctival biopsy specimens showed non-caseating epithelioid cell granulomas with giant cell formation. The lesions partially responded to therapy with topical corticosteroids but persisted for another 4 years and then gradually cleared over the next 5 years. A systemic investigation failed to disclose a specific cause. At the time of writing, the nodules had completely resolved and no associated systemic disease had developed.     

Allergic conjunctival granulomas.

Seven cases are reported from Australia of benign granulomas of the conjunctiva occurring principally in children. Conjunctival granulomas of this kind have not previously been recorded in Australia. Both clinically and histologically they are identical to those described by Ashton and Cook as allergic granulomas of the conjunctiva exhibiting the Splendore-Hoeppli phenomenon.     

Pyogenic granuloma of the lacrimal sac

In this report, we describe three adult patients diagnosed with lacrimal sac pyogenic granuloma. The presenting symptoms were acute dacryocystitis, lacrimal mass, and bloody tears. The nasolacrimal drainage pathway was obstructed in all cases. Radiologic evaluation performed in one patient revealed the presence of a well-defined mass in the sac with homogenous contrast uptake. Histopathologic examination revealed capillary proliferation and inflammatory cells in a fibromyxoid stroma. The patients were followed up for 11–23 months after external dacryocystorhinostomy without recurrence of the tumor or nasolacrimal obstruction. Pyogenic granuloma may develop from the lacrimal sac mucosa and may cause bloody epiphora. Such a tumor is visualized as a hemorrhagic mass lesion, and it may not have a negative effect on the outcome of DCR.     

Choroidal granulomas in systemic sarcoidosis

PURPOSE: To evaluate the clinical course, including response to therapy, of patients with macular and peripapillary choroidal granulomas secondary to systemic sarcoidosis. METHODS: This is a retrospective case study and literature review. Nine patients with choroidal granulomas were identified. Eight patients had a tissue biopsy confirming sarcoidosis; one was diagnosed from clinical history and typical gallium scan. Ocular examinations included fundus examination, fluorescein angiography, and visual field examination. Eight patients had magnetic resonance imaging (MRI) scans looking for intracranial granulomas. Treatment consisted of oral prednisone in eight patients (one with concomitant subconjunctival triamcinolone); one patient received no treatment because of good vision and granuloma in the nasal retina. Variables studied included visual acuity (VA), response of granulomas to treatment, time to recurrence, and associated anterior segment findings. RESULTS: Eight of nine patients had a solitary lesion whereas one had multifocal involvement. The granulomas ranged in size from one half to four disk diameters. Eight patients had blurry vision; one was asymptomatic. All nine patients had hilar adenopathy and/or pulmonary parenchymal disease. No patient had nonocular neurologic symptoms and in eight patients who underwent MRI examination no intracranial granulomas were detected. Of the eyes that were treated (n = 8) all had decrease in the size of the choroidal mass at an average of 4 months of treatment. Two had complete resolution. Mean follow-up was 29.2 months. At the time of initial diagnosis only one patient had an active anterior uveitis. Five of nine patients had at least one recurrence. Mean time to recurrence was 7.6 months after discontinuing oral prednisone. The VA at presentation ranged from 20/30 to 20/300. Final VA was 20/30 or better in all patients. CONCLUSIONS: Choroidal granulomas related to systemic sarcoidosis respond well to oral corticosteroids. They may recur but good vision can be maintained. They are not typically associated with concomitant iritis and also do not appear to be associated with intracranial granulomas.     

Iris granulomas of unknown aetiology

BACKGROUND: Non-pigmented tumours of the iris are rare and their clinical classification can be difficult, especially in the absence of systemic manifestations. HISTORY AND SIGNS: We report the case of a unilateral vascular, non-pigmented iris tumour in a 47-year-old patient. Clinically, the iris lesion showed progressive growth and tumour vascularisation. THERAPY AND OUTCOME: A systemic work-up failed to reveal any underlying systemic disease. Biopsy showed a non-necrotising granuloma. The lesion responded well to systemic corticosteroid therapy. CONCLUSIONS: Isolated granulomas of the iris are rare and clinically often indistinguishable from malignant tumours like melanoma. Due to the clinical course and the regression under corticosteroid therapy we concluded that this iris granuloma may be an isolated ocular manifestation of sarcoidosis.     

Pyogenic granuloma of the lacrimal sac

BACKGROUND: Pyogenic granulomata belong to the group of inflammatory pseudotumours. They consist of granulation tissue usually following inflammatory processes or trauma. PATIENT: We report on a 86-year old female suffering from chronic dacryocystitis. In the course of the treatment exstirpation of the lacrimal sac was performed. The removed tissue was analysed histologically. RESULTS: Histological examination revealed a dense lymphoplasmacellular infiltration underlying the epithelium of the lacrimal sac. A mushroom-like tumour rising into the lumen of the lacrimal sac could be observed. This tumour consisted of capillaries and a dense inflammatory infiltrate. The findings were consistent with a pyogenic granuloma of the lacrimal sac. CONCLUSION: Pyogenic granulomata usually arise in the conjunctiva as a sequel of chronic lipogranulomatous inflammation. They are very rare in other areas such as the lacrimal drainage system.     

Pyogenic granuloma following Smart Plug insertion

CASE REPORT: We report the case of a 65-year-old woman with dry eye syndrome who was referred because of a red mass in the internal left canthus. Three years previously two Smart Plugs had been introduced into both lacrimal punctums of that eye. We diagnosed a pyogenic granuloma and removed it. Two weeks later a new granuloma developed so both the granuloma and the punctal plug were removed. The patient became asymptomatic following this latter procedure. DISCUSSION: A pyogenic granuloma in a Smart Plug punctum is described. This rare complication is generally associated with the use of silicone punctal plugs, being possibly caused by the chronic irritation of the accumulated detritus and necessitating removal of the plug.     

Free-floating Pyogenic Granuloma of the Lacrimal Sac

Abstract

The authors report a 13-month-old girl with chronic dacryocystitis, and history of three times probing and once inferior turbinate infracture. She underwent dacryocystorhinostomy due to failure of previous procedures. During surgery a free floating reddish mass was extracted from the lacrimal sac. Histopathologic examination revealed the mass to be a pyogenic granuloma.     

Pyogenic granuloma associated with chronic Actinomyces canaliculitis

A case of chronic Actinomyces canaliculitis with associated pyogenic granuloma formation and bloody tears is described. Although Actinomyces is a well-known cause of canaliculitis, the authors are not aware that it has been reported in association with pyogenic granulomas.