A Case of Orbital Granuloma Secondary to Dermal Filler Injection

Abstract

A foreign body granulomatous reaction is a rare complication of the subcutaneous injection of fillers. We describe a 57-year-old female that presented with a six-month history of a non-painful, right lower eyelid mass. She had a dermal filler in the zygomatic region several months before the onset of her symptoms. Anterior orbitotomy and pathology revealed multinuclear giant cells consistent with a hyaluronic acid-based filler. This case describes the clinical presentation, histopathologic features, and treatment of an orbital granuloma secondary to dermal filler injection. Our case was uncommon because the zygomatic filler migrated across the orbital septum. Additionally, transconjunctival orbitotomy was used instead of a hyaluronidase injection due to the inferior location of the granuloma.

Keywords: dermal filler; granulomatous reaction; orbital granuloma; orbital mass; transconjunctival orbitotomy.

Figure 1. Gross view of cyst in formalin. Note grey-blue appearance with surrounding membrane with blood vessel and adipose tissue.

Figure 2. Hemotoxin and eosin stain 10 x power view of the cyst lining

The cyst lining is composed of no true epithelial lining; instead, the cyst lining is entirely macrophages and a multinucleate giant cell, encased in a delicate fibrotic rim. Centrally, the acellular grey-blue material (indicated by the black arrow) is being surrounded by multinucleate foreign body giant cells.