Longterm results after therapy of paraffin induced sclerosing lipogranuloma of the eyelids and the anterior orbit in three patients

Background: Chronic lipogranuloma of anterior orbit and the eyelids is a ra re inflammatory pseudotumor with a high tendency of recurrence. It is most commonly related to prior endonasal sinus surgery. History and signs: We report on three patients with chronic lipogranulomata who were treated at the university eye-hospital of Dusseldorf during the l ast 8 years. These cases are discussed individually and longterm results ar e presented. Therapy and outcome: Three patients underwent endonasal surgery with postsu rgical use of paraffin nasal packing prior to the occurrence of chronic lip ogranulomata. Histologic findings uniformly revealed granulomatous processe s but in none was there any sign of a systemic granulomatous disorder (such as Boeck's disease). Additionally, one of these three patients suffered fr om neuroophthalmologic impairment due to infiltration of oculomotore struct ures. Early surgical treatment if only for extended biopsy did result in im mediate severe recurrence of the disease. No recurrence of the disease has been observed, however, if surgery was duely postponed. Conclusions: Lipogranulomata seem to be caused by postsurgical paraffin nas al packing. Early treatment seems to be unfavourable because of the high te ndency of recurrence. Surgical removal of any tumor masses should be delaye d therefore till granuloma formation has presumably come to an end. Any ear ly surgery should be limited to a diagnostic biopsy if judged necessary.