Conjunctival Pyogenic Granuloma Masquerading as Malignant Melanoma.

Pyogenic granuloma is a common, benign, vascular growth that often appears as a rapidly growing mass on mucus membrane-lined surfaces such as the conjunctiva. Conjunctival pyogenic granulomas are common following trauma, burst chalazion or ill-fitting prosthesis. Also known as 'lobular capillary hemangiomas', these lesions typically appear bright red, fleshy and pedunculated. Treatment options include excision, topical steroid therapy and topical beta-blocker therapy. In this communication, the authors describe a rapidly enlarging, pedunculated black coloured conjunctival mass lesion in a 44-year-old woman, who had a recent history of chalazia. Given the location and the clinical appearance, a melanocytic tumour was suspected and the mass was excised. Histopathology and immunohistochemical studies confirmed the diagnosis to be consistent with that of a a necrotic pyogenic granuloma. Pigmented lesions of the conjunctiva, especially rapidly enlarging ones, need to be viewed with a high degree of suspicion to rule out malignant melanoma. Rarely though, benign lesions such as pyogenic granulomas that undergo necrosis may masquerade as conjunctival melanomas.

Occult Foreign Body of the Eyelid Presenting as Recurrent Eyelid Ecchymosis.

Treatment strategies for treating periocular retained foreign bodies depend on the nature of the foreign body, its composition, size, location, and presenting symptoms. Foreign bodies retained in the ocular adnexa can be asymptomatic and lie dormant for long periods of time. In this communication, we present the case of a 32-year-old female who presented with a history of multiple episodes of recurrent edema and ecchymosis of the left lower eyelid, occurring over the past three years. She had been involved in a vehicular accident 13 years ago, which resulted in multiple facial lacerations. She subsequently underwent primary wound repair and two skin grafting procedures. Imaging revealed a hyperdense foreign body located just within the inferolateral orbital rim. An exploration was performed, and a glass foreign body was recovered. We hypothesize that the dormant foreign body had migrated, and repeated microtrauma caused by the sharp edges of the glass piece, either spontaneous or triggered by trivial trauma such as eye rubbing, led to episodes of eyelid hemorrhage and edema. The unique aspects of this case are the unusually long period of quiescence before which the symptoms appeared, the atypical clinical signs, and the eventual recovery of this occult foreign body from the eyelid. This case also underscores the importance of a detailed history and the need for imaging in facial trauma.