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Christopher M Knapp, Malcolm Reed, Elisabeta Farcas, Lin Lu; A Rare Case of Granuloma Faciale affecting the Tarsal conjunctiva. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5151.
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Granuloma faciale (GF) is a chronic rare benign idiopathic dermatosis of unknown aetiology. It usually affects facial skin, although extra-facial involvement has been reported.We describe the first case of GF affecting the tarsal conjunctiva.
A 71 year-old female presented with a 6 months history of a tender, swollen right upper eyelid. Examination revealed mild right sided ptosis. No skin lesions were identified and there was no sign of infection. On eversion of the eyelid the tarsal conjunctiva was uneven with widespread yellow gelatinous infiltrate. There was no regional lymphadenopathy. The best corrected visual acuity was 0.1 (LogMAR). There was no evidence of proptosis. Anterior segment and fundal examination were unremarkable.The differential diagnosis included lymphoma and amyloidosis. Urgent biopsy was performed.
Histology revealed extensive inflammatory infiltrate with irregular zones of macrophages, plasma cells and eosinophils in the conjunctival stroma.Focal collections of neutrophils were present, with no suppuration or active vasculitis. The histological findings were consistent with a diagnosis of GF. EAF was ruled out.The patient was given topical dexamethasone eye drop four times a day following the biopsy. The lesion markedly improved with treatment.
GF is a rare dermatosis typically affecting the skin around the face. Extra-facial skin involvement has been reported. Lesions range in size from a few millimetres to several centimetres. They are elevated and soft with prominent follicles (pores) in various colours: flesh coloured, reddish-brown and bluish-purple. Lesions have never been reported to affect the tarsal conjunctiva. EAF a lesion closely related to GF has rarely been reported to involve the orbit. EAF is an idiopathic inflammatory disorder which typically affects the sinonasal mucosa. The lesions are characterised by progressive submucosa perivascular fibrosis and typically found in the respiratory tract. GF and EAF share a number of histological features and it has been suggested by some authors that the only difference between the two conditions are accounted for by the anatomical site they affect. B cells, T cells and cytotoxic granules play a role in the pathogenesis of both conditions.In our case the histological findings did not support the diagnosis of EAF. The findings were typical of GF.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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