Chronic granulomatous inflammation in subconjunctival silicone oil cyst

Abstract

 

A 54-year-old Asian-Indian woman presented with a blind, painful left eye, with moderate ptosis (A). Her history was significant for repair of a macular hole with silicone oil (SiO) tampon-ade one year previously. Anterior segment examination showed left eye cataract with occlusio pupillae. Conjunctival congestion with multiple cysts (arrow) was seen in the sub-conjunctival space (B). Intraocular pressure was 4 mm Hg. She refused evisceration as an option, and her symptoms remained unchanged with conservative treatment. The subconjunctival cysts were excised under local anesthesia. His-tologic examination showed large, clear cysts surrounded by thin, compact layers of fibrosis (C; hematoxylin-eosin [H&E], original magnification ×100). Few foreign body giant cells (arrow) were seen surrounding the clear vacuoles of silicone oil (D; H&E, ×200). The findings represented a local foreign body reaction to silicone oil likely extruded from prior sclerotomy sites. The patient improved symptomatically after surgery. Silicone oil is used in retina surgery. The use of silicone oil is associated with complications such as SiO emulsification, cataract formation, keratopathy, and glaucoma. The presence of silicone oil in the subconjunctival space is a rare complication. Although considered an inert material, SiO can produce an inflammatory reaction. This case demonstrates chronic granulomatous inflammation around the silicone oil globules, leading to chronic congestion and pain. Removal of the cysts alleviated the patient of her symptoms.