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Last Month’s Blink
Pyogenic Granuloma
Written by Nkechi Nicole Nwabueze, MD, Louise Mawn, MD, and Christine Shieh, MD. Photos by Rocky Munn and Tony Adkins. All are at Vanderbilt Eye Institute, Nashville, Tenn.
A 44-year-old woman presented with a two-week history of a new, enlarging lesion in her right lower eyelid. It had appeared after she had difficulty removing a contact lens (Fig. 1).
She had no ocular pain, tenderness, or discharge. Her past medical and ocular history was notable only for an episode of keratoconjunctivitis four years earlier (worse in the right eye than in the left).
Corrected VA was 20/20 in both eyes, and her IOP was normal. Slit-lamp examination showed a reddish, vascular, lobulated lesion on the palpebral conjunctiva of the right eye. The lesion was determined to be consistent with a pyogenic granuloma, also known as a lobular capillary hemangioma. The rest of the exam was unremarkable.
Treatment options were discussed with the patient, and she elected to try topical medical therapy and conservative management.
The patient was asked to discontinue contact lens wear temporarily, and she was started on prednisolone acetate 1% four times daily and timolol 0.5% twice daily. Significant improvement was seen at follow-up three weeks later (Fig. 2).
Pyogenic granulomas are not infrequently associated with chalazia, and it was strongly suspected that there was a link in this patient’s case.
In some cases, these chalazia need to be excised for maximal improvement.
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