Causative factors and outcomes of pyogenic granulomas presenting to a hospital eye clinic

Ocular pyogenic granulomas are benign vascular lesions that can be highly responsive to topical therapy in community optometry settings, helping to reduce unnecessary burden on tertiary eye care services.

While their rapid onset and vascular appearance can be clinically alarming, the management of pyogenic granuloma primarily involves topical pharmaceuticals well suited to community-based care. This study analyses a 15-year cohort to establish the efficacy of topical management and define clear criteria for surgical referral.

A retrospective audit was performed on 49 cases of ocular pyogenic granuloma presenting to a hospital-based acute eye clinic between 2009 and 2024. Analysis focused on patient demographics, inciting triggers, resolution rates of various topical treatments, in addition to the clinical characteristics of cases requiring surgical intervention.

The median patient age was 40.0 years (IQR 13.0-48.0), with significant male (65.3%) and right-eye (65.3%) biases (both p = 0.044). Ruptured chalazia were the primary trigger (67.3%). Topical medications achieved complete resolution in 83.7% of cases. Fluorometholone demonstrated a 95.5% success rate, whereas Maxitrol achieved resolution in 71.4% of cases. Only 16.3% (7/43) of those treated with topical medications required surgical intervention. The median time to resolution was 1.0 month (IQR 1.0-2.0). Of all the 49 cases, a total of 11 (22.4%) were managed with surgical excision. Recalcitrant lesions (22.4%) were successfully managed with surgical excision without further recurrence.

Most ocular pyogenic granulomas can be safely managed in primary care. Given their expertise in slit-lamp differential diagnosis and intraocular pressure monitoring, community optometrists are ideally positioned to initiate first-line topical steroid therapy, reserving surgical referral for recalcitrant lesions. Establishing this primary-care-first pathway ensures efficient patient care and prioritises tertiary resources for complex surgical cases.