Intraconal grease-gun injury: a therapeutic dilemma

The case of a 31-year-old man with an accidental grease-gun injury to his left orbital region is presented. CT and MRI showed a well-delineated intraconal cyst in the superior aspect of the left orbit surrounded by a significant inflammatory response. The patient was followed for 11 months. Diplopia was not reported at any time, and visual acuity, visual fields, and all other examinations remained normal. Uneventful surgical removal was performed at the patient's request. Histopathologic examination demonstrated a typical picture of lipogranulomatous inflammation. In a review of the accessible literature, only four cases of intraorbital grease-gun injuries were detected; all of them submitted to early surgical removal. We conclude, however, that an intraconal oil/grease cyst can be carefully monitored and--in the absence of symptoms--must not necessarily be removed.