Intra-orbital fat necrosis following transcaruncular orbitotomy mimicking a surgical site infection: A case report

Abstract

Fat necrosis is a benign non-suppurative inflammation of adipose tissue most commonly occurring in breast, subcutaneous tissue or intraabdominal fat post trauma, surgery, radiation. Transcaruncularorbitotomy provides a safe, rapid, and cosmetically pleasing approach to the medial wall and orbital apex. Intraorbital fat necrosis as its complication has not been documented in literature. The authors report the case of an elderly lady who presented with localized pain, swelling following a transcaruncular orbitotomy for excision biopsy of an orbital vascular mass. The etiology, clinical presentation, intraoperative finding, imaging, and possible mechanisms contributing to the pathogenesis of postsurgical orbital fat necrosis has been suggested.

Keywords: Orbit; Transcaruncular orbitotomy; fat necrosis; non encapsulated.

Figure 1

(a) Worm’s view showing left eye proptosis; (b and c) Computed tomography scans of orbits (mid axial and coronal sections) showing well-defined homogeneous mass involving the left mid and posterior orbit extending up to the apex, abutting the optic nerve and in close proximity to the left superior oblique muscle; (d) Photomicrographs shows intravascular glomeruloid like endothelial and spindle cell proliferation with bland nuclear morphology (H and E stain, ×10)

Figure 2

(a) Clinical photograph showing pale yellow mass (black arrow) prolapsing through the conjunctival wound; (b and c) Computed tomography scans of orbits (coronal and midaxial sections) showing ill-defined mixed tissue density along the left medial wall extending up to the orbital apex causing temporal displacement of globe; (d) Per-operative photograph showing pale orbital fat (black arrow) filling the medial orbit space; (e) Photomicrograph shows ghost-like pale staining adipocytes with fibrin thrombi in the necrosed vessels (H and E stain, ×10)