Bilateral Eyelid Pseudoptosis From Lipogranulomas of the Preaponeurotic Fat Pads.
Lipogranulomas of the periocular tissues with fulminant fibrotic and lymphohistiocytic responses were initially described in cases of exogenous paraffin or petrolatum jelly injections ("paraffinomas"). A 49-year-old Cambodian woman slowly developed bilateral pseudoptosis with intact levator function and redundant, taut upper eyelid skin. At surgery, vesiculations or "bubbles" in the preaponeurotic fat were encountered and were demonstrated histopathologically to be empty locules surrounded by a thin collagenous lamina. Outside these extracellular spaces were CD68/CD163-positive mononucleated and univacuolated histiocytes simulating damaged fat cells or neoplastic lipoblasts in hematoxylin and eosin sections. Giant cells and chronic sclerosing inflammation were absent. The patient denied any previous injections. The bland character of the lipogranulomas in comparison with that of other injectable agents, the absence of any residual particles associated with other cosmetic fillers, and the distinctive histiocytic response of lipoblast-like cells that were sufficiently characteristic to compel the diagnosis of surreptitious silicone injections. Other conditions were excluded based on comparative clinicopathologic criteria.
*David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, †Ophthalmic Plastic Surgery, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; and ‡Harvard Medical School, Boston, Massachusetts, U.S.A.
Frederick A
FA
Jakobiec
Ruju
R
Rai
Alia
A
Rashid
Francis C
FC
Sutula
D017667:Adipocytes / Q000473:pathology; D000273:Adipose Tissue / Q000473:pathology*; D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D019882:Blepharoplasty; D001763:Blepharoptosis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D005260:Female; D006099:Granuloma / Q000150:complications* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008068:Lipomatosis / Q000150:complications* / Q000378:metabolism / Q000473:pathology; D008875:Middle Aged; D011956:Receptors, Cell Surface / Q000378:metabolism; D013601:T-Lymphocytes / Q000473:pathology; D014617:Vacuoles / Q000473:pathology; D000098902:CD163 Antigen; D000097382:CD68 Molecule
D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D015415:Biomarkers; D011956:Receptors, Cell Surface; D000098902:CD163 Antigen; C067980:CD68 antigen, human; D000097382:CD68 Molecule