Periocular Petrolatum

Abstract

The diagnosis of petrolatum deposition can be challenging due to the range of symptoms and variable delay in presentation. Petrolatum products should be avoided during surgery and used judiciously in the postoperative period. To avoid confusion with nonspecific cases of lipogranulomatous inflammation, the terms "ointment granuloma" or "orbital paraffinoma" should be used to refer to patients presenting with orbital/eyelid lesions caused by ointment use.

Palpebral Lipogranuloma Caused by Transcanalicular Ointment Injection After Laser Canaliculoplasty

“…Several different terms are used to describe these lesions in the literature, such as lipogranuloma, paraffinoma, oil granuloma, ointment granuloma, paraffin granuloma, and vaselinoma. 9 Here we use the term lipogranuloma.…”

Ointment Granulomas Following Sutureless Transconjunctival Blepharoplasty

“…Similar granulomas have resulted from ointments in nasal packing after sinonasal surgery. 10,22,23 They have been reported in the orbit, eyelids, and lacrimal sac following cosmetic self-injection, 18 exposure to pressurized hydraulic oil during explosion, 24 usage of petroleum-based radiopaque markers during surgery, 19,25 and therapeutic lacrimal duct injection. 13,26 The complication has occurred when ointment was introduced into the socket after enucleation 10,27 and following transcanalicular injection in laser canaliculoplasty.…”

“…16 There are a few reports of ointment granuloma following simple topical application to the conjunctiva. 6,10,15 Transconjunctival lower eyelid blepharoplasty was first described by Bourquet 1 in 1924 and later popularized by Tessier 28 in the 1970s, advocating the conjunctival approach to remove herniated fat and to access the orbital floor in repairing congenital malformations. The procedure has since gained great popularity, offering an advantage over the transcutaneous method by avoiding lower eyelid malposition and external scars.…”

“…20 Ophthalmic ointments that include white petrolatum, paraffin, and mineral oil can stimulate a foreign body granulomatous reaction when exposed to subconjunctival blood vessels. 6,10,20,21 Heidingsfeld 21 in 1906 first described a foreign body reaction to lipid substances introduced for cosmetic and prosthetic procedures. Similar granulomas have resulted from ointments in nasal packing after sinonasal surgery.…”

“…10 Other descriptive idioms include sclerosing lipogranulomas, 11,12 lipogranulomas, [13][14][15][16] lipid granulomas, 13 Lacrilube cysts, oil granulomas, 17 oleogranulomas, 17,18 and Vaselinoma. 19 Petrolatum jelly products are composed of saturated hydrocarbons known as n-alcanes that are indigestible by cellular enzymes.…”