Sclerosing lipo-granuloma in the orbit.

THIS case is reported as a mass in the lower lid presumed to be due to " sclerosing lipo-granuloma". Case Report A boy aged 16 years reported at the Surbiton Branch of the Royal Eye Hospital on December 29, 1956, complaining of a painless swelling in his left lower lid which had appeared gradually during the past 7 days. He had received a light blow from a fist on his left eye while "fooling around with a friend" about 4 weeks previously, i.e. in the first week of December. The swelling had subsided uneventfully in the course of a week to 10 days, but 7 days before attending hospital it had re-appeared and had gradually become larger. There was no pain, tenderness, lacrimation, diplopia, or enlargement on sneezing or coughing. Examination. -The visual acuity was 6/9 unaided in the right eye and 6/9 less 2 unaided in the left eye. The mass involved the entire width of the lower lid and extended to an inch below the lid margin. It was firm in consistency, although rather irregularly so, as if there were calcareous nodules in it. There was no tenderness on firm pressure, no fluctuation, and no transillumination. The skin was bound down to the mass which could not be distinguished from the orbital margin, nor moved away from it. There was some chemosis of the bulbar conjunctiva at the outer angle and some oedema of the upper lid. The pre-auricular lymph node was not palpable. There was no proptosis, and no limitation of ocular movement. The eye was quiet and the fundus appearance normal. X ray of the left orbit revealed no bony injury and no bony deposits in the left lower lid. Diagnosis, Treatment, andProgress.-A provisional diagnosis of unresolved haematoma with renewed bleeding was made, and a subcutaneous injection of 1,000 units hyaluronidase in 1 ml. distilled water was given into the mass through the skin. The swelling partly subsided during the next few days. By January 14, 1957, the swelling had become appreciably larger. There was slight proptosis and limitation of action of the inferior rectus muscle presumably caused mechanically by the pressure of the mass. The visual acuity in the left eye was recorded as 6/12. There was no pyrexia and no tenderness. On January 19, 1957, the swelling had still further increased in size and was causing considerable displacement upwards and a little outwards. Eye movements were limited in all directions, there was more chemosis, the left upper lid was more oedematous, and a mass not previously noted was palpable in the outer corner of the left upper lid. This was also firm but differed from the mass in the lower lid in having well-defined edges; it was not attached to skin and was freely movable over the orbital margin. There was no palpable isthmus between this and the larger mass. No pre-auricular adenopathy was found, but the left tonsillar lymph gland was palpable. The patient was admitted to hospital for further investigations and observation. General examination revealed an asthenic build with pigeon chest and lumbar kyphosis. There were small palpable axillary lymph nodes, but no lesions were found in the circulatory, respiratory, or cardiovascular systems. The blood pressure was 120/80.