Silicone Migration: An Unusual Eyelid Complication Following Intraocular Surgery.

Ultrasound imaging is not traditionally employed to evaluate eyelid lesions. Nevertheless, this technology permits the delineation of static and dynamic changes and could be useful in evaluating eyelid masses by providing additional information to clinicians for optimal surgical planning, especially in facilities where a computed tomography (CT) scan is not readily available. A 63-year-old woman presented in April 2014 with a painless mass in the right upper lid (RUL) associated with ptosis (Figure 1A) that had gradually developed during the previous 10 months. Retinopexy associated with vitrectomy with intraocular silicone oil filling was performed 15 months before to treat a retinal detachment in the right eye. Silicone oil was removed 8 months later. For the past 4 months, patient was under investigation for a breast nodule. Marginal reflex distance (MRD-1) was −1 on the right and+3 on the left side. Levator function was 13 and 15 mm. Best corrected visual acuity was counting fingers 2 m and 20/20. Fundoscopy in right eye did not permit periphery evaluation due to poor dilation. The remainder of the ophthalmological examination revealed no abnormalities. Differential diagnosis of a noninflammatory eyelid lesion includes benign and malignant tumors, eyelid metastasis, and vascular lesions. Since the patient had a history of a breast nodule, an eyelid metastatic lesion had to be ruled out. While we waited for CT scan, ultrasound examinations were performed. Ultrasound biomicroscopy (UBM) showed cystic formations with anechoic content underneath the muscular layer of the RUL. There was significant attenuation of the posterior structures, ruling out hematic, serous, or purulent content (Figure 2B,C). B-scan ultrasonography was next performed and showed a hypoechoic space in the RUL-containing material causing sound attenuation and an artificial lengthening of the echogram, suggesting the presence of a substance with a lower speed of sound propagation compared with the vitreous (Figure 2A). B-scan thus ruled out a tumor or a metastatic lesion but not a low-flow vascular lesion. Doppler examination showed a cystic and lobulated lesion, and flowmetry did not depict any internal blood flow, ruling out a vascular lesion (Figure 2D). Figure 1. (A) This 63-year-old woman presented with a painless mass in the right upper eyelid associated with upper lid ptosis that had gradually developed for 10 months. (B) Final aspect 1 year after excision of the mass and reinsertion of the levator aponeurosis to the tarsus.