Conjunctival Pyogenic Granuloma after Sub-tenon’s Block

Purpose: We report a case of conjunctival pyogenic granuloma that developed after sub-Tenon’s block at the inferotemporal conjunctival quadrant during cataract surgery. Case summary: A 74-year-old male patient with senile cataract, diabetic retinopathy and open-angle glaucoma, who was using a combination of timolol/tafluprost and brimonidine eyedrops, underwent uneventful cataract surgery after sub-Tenon’s block at the inferotemporal conjunctival quadrant of his right eye. Moxifloxacin, 1% prednisolone acetate and 0.1% bromfenac sodium hydrate were administered daily for 1 month post-surgery, by which time a pink-colored, oval-shaped granulomatous mass had developed on the inferotemporal conjunctiva, at the site of the sub-Tenon’s block. Dexamethasone and antibiotic combination eye drops were administered without resection of the mass, which had markedly regressed after 2 weeks and disappeared completely 6 weeks after treatment. Conclusions: Patients should be informed of the possibility of conjunctival pyogenic granuloma prior to cataract surgery using sub-Tenon’s block, and it is important to carefully check the block site and compliance with eyedrops at follow-up visits. Conjunctival pyogenic granuloma can be successfully treated with topical steroids. J Korean Ophthalmol Soc 2021;62(4):566-570

[1]  Hyung Bin Hwang,et al.  Histopathologic Analysis of Conjunctival Lymphoproliferative Disease After Topical Brimonidine Use. , 2019, Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics.

[2]  Pinyi Chen,et al.  Clinicopathologic Characteristics and the Surgical Outcome of Conjunctival Granulomas After Pterygium Surgery , 2018, Cornea.

[3]  J. Carlin,et al.  Conjunctival Ultraviolet Autofluorescence as a Measure of Past Sun Exposure in Children , 2017, Cancer Epidemiology, Biomarkers & Prevention.

[4]  M. Vermeulen,et al.  Benzalkonium chloride breaks down conjunctival immunological tolerance in a murine model , 2012, Mucosal Immunology.

[5]  C. Kumar,et al.  Sub-Tenon's anaesthesia: complications and their prevention , 2011, Eye.

[6]  C. Kumar,et al.  A comparison of infero‐nasal and infero‐temporal sub‐Tenon's block* , 2006, European journal of anaesthesiology.

[7]  G. Lueder,et al.  Conjunctival pyogenic granulomas after strabismus surgery. , 2005, Ophthalmology.

[8]  M. Dujovny,et al.  Perivascular delivery of neomycin inhibits the activation of NF-κB and MAPK pathways, and prevents neointimal hyperplasia and stenosis after arterial injury , 2004, Neurological research.

[9]  S. Brownstein,et al.  Pyogenic granuloma following oculoplastic procedures: an imbalance in angiogenesis regulation? , 2001, Canadian journal of ophthalmology. Journal canadien d'ophtalmologie.

[10]  T. Nakamura,et al.  Apoptosis and expression of Bax/Bcl‐2 proteins in pyogenic granuloma: a comparative study with granulation tissue and capillary hemangioma , 2000, Journal of cutaneous pathology.

[11]  F. Auclin,et al.  Sub-Tenon’s anaesthesia: an efficient and safe technique , 1997, The British journal of ophthalmology.

[12]  L. Clearkin Adverse effects of topical antiglaucoma medication. , 1995, Archives of ophthalmology.

[13]  C. O'brien,et al.  Adverse effects of topical antiglaucoma medication. II. The outcome of filtration surgery. , 1994 .

[14]  H. Leibowitz,et al.  Drug interaction in the eye. Concurrent corticosteroid-antibiotic therapy for inflammatory keratitis. , 1977, Archives of ophthalmology.

[15]  A. P. Ferry Pyogenic granulomas of the eye and ocular adnexa: a study of 100 cases. , 1989, Transactions of the American Ophthalmological Society.