title: Ointment Granulomas Following Sutureless Transconjunctival Blepharoplasty: Diagnosis and Management.
abstract: OBJECTIVE
  To describe a case series of ointment granuloma as a complication of sutureless transconjunctival blepharoplasty.
  
  
  METHODS
  A retrospective review of the medical records of 8 patients with this complication was conducted, including the histopathology of excised tissues. Institutional review board oversight was waived as this was not an institutional study but a Health Insurance Portability and Accountability Act-compliant retrospective chart review from the private medical practice of one of authors' coauthors. It adhered to the principles set forth in the Declaration of Helsinki.
  
  
  RESULTS
  Eight patients developed painless lower eyelid and anterior orbital masses following presumed successful blepharoplasty. Each had received intra- or immediate postoperative lubricating ointment. The mean time from surgery to appearance of the lesions was 50 days (range: 9 days-10 months). Three patients responded to intralesional injection of steroid with complete resolution. Five patients required surgical excision of the lesions without recurrence to date. Histopathological examination of the excised tissues revealed large, pleomorphic lipid-dropout pools bordered by attenuated histiocytes and giant cells.
  
  
  CONCLUSIONS
  The appearance of eyelid lumps or fullness in the early and mid-postoperative recovery should suggest ointment granuloma. If recognized early, management should commence with intralesional injection of steroids, although the definitive treatment is surgical excision. The authors recommend minimizing the access of topical ointments to the open inferior fornix, placing the medication sparingly onto the cornea at the close of surgery and instructing patients in avoiding overuse.
authors.affiliation: *Department of Ophthalmology, †Institute of Reconstructive Plastic Surgery, and ‡Department of Pathology, New York University Langone Medical Center, New York, New York, U.S.A.
authors.forename: Irina
authors.initials: I
authors.lastname: Belinsky
authors.forename: Payal
authors.initials: P
authors.lastname: Patel
authors.forename: Norman C
authors.initials: NC
authors.lastname: Charles
authors.forename: Richard D
authors.initials: RD
authors.lastname: Lisman
mesh_terms: D000328:Adult; D000368:Aged; D019882:Blepharoplasty; D003228:Conjunctiva / Q000601:surgery; D005141:Eyelid Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D015745:Granuloma, Foreign-Body / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D009824:Ointments / Q000009:adverse effects*; D013508:Ophthalmologic Surgical Procedures; D009916:Orbital Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D010577:Petrolatum / Q000009:adverse effects*; D012189:Retrospective Studies; D013536:Suture Techniques
chemical_list: D005938:Glucocorticoids; D009824:Ointments; D010577:Petrolatum