Department of Ophthalmology, Shanghai Jiaotong University, Shanghai, People's Republic of China.
Ophthalmic Plast Reconstr Surg. 2011 Sep-Oct;27(5):333-7. doi: 10.1097/IOP.0b013e31821b6d92.
Laser canaliculoplasty is widely used to treat lacrimal duct obstruction. We describe 12 patients in whom eyelid lipogranuloma developed subsequent to laser canaliculoplasty, followed by tobramycin and dexamethasone, ofloxacin, or erythromycin ointment injected in the lacrimal duct.
Clinical history, ocular workup, and CT were performed. Histopathologic examination was performed after eyelid tissue excision.
Over a period of 3 years, 12 patients were diagnosed with eyelid lipogranuloma caused by diffusion and deposition of ointment. Seven of 12 patients were injected with tobramycin and dexamethasone ointment, 3 patients were injected with ofloxacin ointment, and 2 patients were injected with erythromycin ointment. Histopathologic features of the excised tissue included multifocal spaces surrounded by multinucleated giant cells, considered to be lipogranulomatous inflammation.
The incidence of lipogranuloma caused by transcanalicular ointment injection after laser canaliculoplasty is low. Surgical excision of the lipogranuloma should be performed only when it becomes relatively localized and has passed the acute phase of inflammation to avoid the recurrence of lipogranuloma and diffusion of the inflammation. A cosmetic outcome should be considered, and simultaneous blepharoplasty with transplantation of herniated fat pads may be performed in either or both eyelids to achieve a satisfactory appearance. Injection of ointment in the lacrimal duct should be avoided, as it might create unnecessary complications when a new channel is created or when canalicular walls are penetrated. Local massage after ointment injection is not recommended.
激光泪道成形术广泛用于治疗泪管阻塞。我们描述了 12 例患者，他们在激光泪道成形术后，因在泪管内注射妥布霉素和地塞米松、氧氟沙星或红霉素眼膏而继发眼睑脂肉芽肿。
进行了临床病史、眼部检查和 CT 检查。切除眼睑组织后进行了组织病理学检查。
在 3 年期间，12 例患者被诊断为眼膏扩散和沉积引起的眼睑脂肉芽肿。12 例患者中有 7 例注射妥布霉素和地塞米松眼膏，3 例注射氧氟沙星眼膏，2 例注射红霉素眼膏。切除组织的组织病理学特征包括被多核巨细胞包围的多灶性腔隙，被认为是脂肉芽肿性炎症。
激光泪道成形术后经泪小管注射眼膏引起脂肉芽肿的发生率较低。只有当脂肉芽肿相对局限并已过炎症急性期时，才应进行手术切除，以避免脂肉芽肿复发和炎症扩散。应考虑美容效果，并且可能需要在单眼或双眼同时进行眼睑成形术和疝出脂肪垫移植，以获得满意的外观。应避免在泪管内注射眼膏，因为在创建新通道或穿透泪小管壁时可能会产生不必要的并发症。不建议在眼膏注射后进行局部按摩。
