Ointment related granulomas post-blepharoplasty
Reviewed by James Hsuan

This is a retrospective review of eight patients who developed granulomatous masses after lower lid blepharoplasty. All patients had sutureless bilateral trans-conjunctival surgery, and lubricating ointment was instilled into the inferior fornix postoperatively for two days. Painless lower lid masses developed between nine days and 10 months following surgery. In all but one patient this was bilateral. Seven patients were treated with intra-lesional steroid with or without oral steroids and antibiotics, and five patients required surgical excision before resolution was achieved. Histopathology showed large lipid-laden areas surrounded by a foreign body giant cell reaction, consistent with petrolatum induced granulomatous inflammation. This is an interesting case series of a relatively rare complication of blepharoplasty surgery. Avoidance of the complication by closing the wound is discussed, but the use of sutures is not without risk, and they can occasionally also cause significant inflammation and lid retraction. It may be preferable to avoid the use of petrolatum ointments when entrapment within the tissue is a possibility. Although the authors suggest initial treatment should be with intra-lesional steroid, recurrence following injection was common and the majority of their patients required surgical debulking before resolution. There were no recurrences following surgery.

Ointment granulomas following sutureless transconjunctival blepharoplasty: Diagnosis and management.
Belinsky I, Patel P, Charles NC, Lisman RD.
OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY
2015;31:282-6.