Delhi Journal of Ophthalmology

Triple Impression Granuloma: A Rare Case of Conjunctival Shaping by Neglected Ocular Conformer

Rinky Agarwal, Rebika Dhiman, Navneet Sidhu, Kumar Kartikay Rajaura 
Department of Ophthalmology Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences, New Delhi, India

Corresponding Author:

Rinky Agarwal (MD)
Dr Rajendra Prasad Centre for Ophthalmic Sciences
All India Institute of Medical Sciences, New Delhi, india
Email : rinky.1990@gmail.com

Received: 22-SEP-2020

Accepted: 09-OCT-2020

Published Online: 09-JUL-2021

DOI:http://dx.doi.org/10.7869/djo.675

Abstract
Ocular conformers are small, acrylic-cup shaped devices that are placed inside anophthalmic sockets for 6-8 weeks following surgical removal of eyeball (evisceration or enucleation) till definitive ocular prosthesis can be fabricated for aesthetic pleasure. As these are temporary devices, it is rare to encounter any complications due to their presence. Conjunctival granulomas are fibrovascular proliferation as a result of chronic irritation to the conjunctival tissues. Impression granulomas are rarely reported in literature. Here, we report a case of triple impression granuloma of the conjunctiva that was encountered in a middle-aged male due to neglected conformer.

Keywords :Pyogenic Granuloma; Conformer; Conjunctiva

Photo essay
Conjunctival pyogenic granulomas (CPGs) are usually associated with ocular surgeries such as enucleation, evisceration and exenteration, and surgeries related to pterygium, lacrimal duct obstruction, strabismus or eyelid reconstruction and integrated orbital implants.1 Angiogenic imbalance during wound healing resulting in excessive vasoproliferation and cellular infiltration contributes to their origin.1

A 45-year-old male with right eye phthisis post wet-lime injury wearing a suitable-size ocular conformer continuously without replacement for past 3-months presented with pain, discharge, lid edema, congestion and inability to open eyelids for 10 days. After giving oral analgesic-antiinflammatory-antibiotic combination for relaxing tense edematous upper and lower eyelids, excessively tight-fitting conformer with surrounding chemosed conjunctiva were visualized. Removal of conformer revealed three CPGs with apical flattening and necrosis conforming to the shape of the conformer vents along with accumulation of yellow lacy discharge (Figure 1). Differential diagnosis of such masses including conjunctival cysts, abscesses and cancerous lesions were ruled out by reactive nature and solid consistency of CPG and younger age. Thorough cleaning of socket with betadine 5% was undertaken and topical steroid-antibiotic-combination were prescribed. By 4-weeks follow-up, CPGs decreased in size with complete symptomatic relief (Figure 2).




Ocular conformers (Figure 3) are small, acrylic-cup shaped devices that are placed inside anophthalmic sockets for 6-8 weeks following surgical removal of eyeball.2,3 A relatively benign-appearing conformer, when neglected, as seen presently, can incite persistent mechanical irritation of conjunctiva resulting in its chronic edema. The intermittently located conformer vents then act as exhausts for conjunctival overgrowth, casting their shape onto them thereby creating an impression granuloma. Prolonged environmental exposure through these vents leads to dehydration and ischemia of apices of CPGs. Initial course of non-steroidal-anti-inflammatory agents may facilitate extraction of conformer by reducing lid edema, while topical corticosteroids remain the mainstay of therapy. All patients harboring them must be advised regular follow-up to avoid such untoward complications.



References
  1. Wu D, Qian T, Nakao T, Xu J, Liu Z, Sun X, et al. Medically uncontrolled conjunctival pyogenic granulomas: correlation between clinical characteristics and histological findings. Oncotarget. 2016 Dec 19;8(2):2020–4. 
  2. Koch KR, Trester W, Müller-Uri N, Trester M, Cursiefen C, Heindl LM. Ocular prosthetics. Fitting, daily use and complications]. Ophthalmologe. 2016 Feb;113(2):133–42. 
  3. Patel BCK, Sapp NA, Collin R. Standardized Range of Conformers and Symblepharon Rings. Ophthalmic Plastic & Reconstructive Surgery. 1998 Mar;14(2):144.

CITE THIS ARTICLE

Agarwal R, Dhiman R, Sidhu N, Rajaura KKTriple Impression Granuloma: A Rare Case of Conjunctival Shaping by Neglected Ocular Conformer.DJO 2021;31:114-115

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Agarwal R, Dhiman R, Sidhu N, Rajaura KKTriple Impression Granuloma: A Rare Case of Conjunctival Shaping by Neglected Ocular Conformer.DJO [serial online] 2021[cited 2021 Jul 28];31:114-115. Available from: https://www.djo.org.in/articles/31/4/Triple-Impression-Granuloma.html