Palpebral lipogranuloma caused by transcanalicular ointment injection after laser canaliculoplasty

Laser canaliculoplasty is widely used to treat lacrimal duct obstruction. We describe 12 patients in whom eyelid lipogranuloma developed subsequent to laser canaliculoplasty, followed by tobramycin and dexamethasone, ofloxacin, or erythromycin ointment injected in the lacrimal duct.

Clinical history, ocular workup, and CT were performed. Histopathologic examination was performed after eyelid tissue excision.

Over a period of 3 years, 12 patients were diagnosed with eyelid lipogranuloma caused by diffusion and deposition of ointment. Seven of 12 patients were injected with tobramycin and dexamethasone ointment, 3 patients were injected with ofloxacin ointment, and 2 patients were injected with erythromycin ointment. Histopathologic features of the excised tissue included multifocal spaces surrounded by multinucleated giant cells, considered to be lipogranulomatous inflammation.

The incidence of lipogranuloma caused by transcanalicular ointment injection after laser canaliculoplasty is low. Surgical excision of the lipogranuloma should be performed only when it becomes relatively localized and has passed the acute phase of inflammation to avoid the recurrence of lipogranuloma and diffusion of the inflammation. A cosmetic outcome should be considered, and simultaneous blepharoplasty with transplantation of herniated fat pads may be performed in either or both eyelids to achieve a satisfactory appearance. Injection of ointment in the lacrimal duct should be avoided, as it might create unnecessary complications when a new channel is created or when canalicular walls are penetrated. Local massage after ointment injection is not recommended.