Pyogenic granuloma (exuberant granulation tissue) appears as a fleshy, red, pedunculated, nodular elevation on the conjunctival surface, typically occurring in association with a chalazion (on the palpebral conjunctiva) or a punctum or at a site of prior accidental or surgical trauma. Granulation tissue is a reparative process that is necessary for wound healing after inflammation or injury. The term “pyogenic granuloma” is a misnomer because the lesion is not pus producing and is not granulomatous. Rather, pyogenic granuloma is an exuberant proliferation (overgrowth) of granulation tissue composed of acute and chronic inflammatory cells and radially arranged, proliferating capillaries within a loose connective tissue framework (Fig 5-10).
Figure 5-9 Conjunctival foreign-body granuloma. A, Clinical appearance on the bulbar conjunctiva. B, Histologic analysis of the specimen (from a different patient) under polarized light shows multiple refractile foreign fibers (arrows).C, Hematoxylin-eosin (H&E) stain demonstrates fibers with surrounding foreign-body granulomatous reaction, including multiple giant cells (arrowhead).
(Part A courtesy of Anthony J. Lubniewski, MD; part B courtesy of George J. Harocopos, MD; part C courtesy of Tatyana Milman, MD.)
Excerpted from BCSC 2020-2021 series: Section 4 - Ophthalmic Pathology and Intraocular Tumors. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.