Orbital Granuloma Faciale: Case Report and Literature Review
Author: Anahita Dadali
Base Hospital / Institution: St George’s University Hospital
ePoster presentation
Abstract ID: 25-531
Purpose
To describe a rare case of orbital granuloma faciale with eosinophilic angiocentric fibrosis presenting as a disfiguring, chronic orbital mass and to outline its management and histopathological features.
Methods
Retrospective case report and literature review.
Results
A 19-year-old female was referred for evaluation of a five-year history of progressive right lower eyelid swelling, vertical diplopia, and orbital discomfort. An initial cutaneous biopsy performed under dermatologic care was suggestive of granuloma faciale. Treatment with hydroxychloroquine was ineffective, and systemic immunosuppression was subsequently discontinued. On ophthalmic examination, findings included upper and lower eyelid edema, hyperglobus, restricted vertical motility, and a firm, well-circumscribed mass along the inferior orbital rim. Orbital MRI revealed a retrobulbar lesion involving the inferior rectus and inferior oblique muscles. The patient underwent an anterior orbitotomy with subtotal debulking of the mass, which appeared intraoperatively as firm, avascular, and cartilage-like. Residual components encasing extraocular muscles were treated with intralesional dexamethasone. Histopathological analysis confirmed granuloma faciale with features of eosinophilic angiocentric fibrosis. Postoperatively, a tapering course of oral corticosteroids led to improvement in eyelid swelling and ocular motility; however, vertical diplopia persisted. Immunomodulatory treatment with mycophenolate mofetil is planned, with potential consideration of biologic agents pending rheumatologic evaluation.
Conclusion
Orbital involvement in granuloma faciale is rare and may mimic other orbital inflammatory or neoplastic entities. Diagnosis requires a high index of suspicion and histopathological confirmation. Multimodal management, including surgical debulking and immunosuppression, may be necessary to achieve symptomatic control.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Kaveh | Vahdani | Moorfields Eye Hospital |
