Adnexal Service, Moorfields Eye Hospital, London, United Kingdom.
Ophthalmic Plast Reconstr Surg. 2021;37(3):226-229. doi: 10.1097/IOP.0000000000001848.
To evaluate the presentation, treatment, and outcome for patients with peribulbar dermolipomas and describe a reliable technique for excision of large lesions.
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.
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.
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.
评估眶周皮脂瘤患者的表现、治疗和结局，并描述一种切除大型病变的可靠技术。
对 1976 年至 2019 年在 Moorfields 眼科医院就诊的患者进行回顾性图表审查。回顾患者的人口统计学资料、临床特征、影像学（CT 或 MRI，如有）、组织病理学和手术结果。
共 187 例患者的 196 只眼被诊断为皮脂瘤，患者的平均年龄为 21.5 岁，在 163 例有记录的患者中，首次出现症状的平均年龄为 12.9 岁。虽然 8/187（4%）例患者无症状，但最常见的症状是长期眶周肿块逐渐增大（136 例；73%）；其他症状包括眼部刺激（24%）、间歇性局部结膜充血（12%）和粘液性分泌物（12%）。三分之一的皮脂瘤可见毛发（部分伴有局部巨大乳头性结膜炎），44 例患者有外侧泪点增宽，8 例患者有异常的泪腺导管开口于皮肤，9 例患者有复杂的外侧泪点异常，同时有外侧皮样瘤和内侧皮脂瘤。120 例患者（1990 年后治疗的患者）和 40 例患者（33%）接受了观察，71 例患者（59%）因长期刺激和分泌物而行切除术，9 例患者（8%）因美容原因而行切除术：在所有情况下，与完整的皮下脂肪小叶一起，异常的非湿润鳞状上皮均在显微镜控制下被描绘和切除，结膜缺损直接（59/80 只眼）或采用“V 至 Y”闭合（21 只眼；26%）。除 1 例患者外，所有患者的首发症状均得到治愈，该患者因持续存在的症状需要切除残余异常上皮。2 例患者在直接结膜闭合后出现外侧泪点处的假性睑球粘连，但无功能影响，2 例其他患者存在极度水平眼球运动受限。
当皮脂瘤随年龄增长变得更加突出，或开始引起眼部刺激和分泌物时，可能需要手术治疗。当小心切除非湿润鳞状上皮并直接进行结膜闭合，或使用“V 至 Y”结膜成形术治疗较大的缺损时，并发症很少。
