Pyogenic Granuloma of the Conjunctiva

A hard, painless lump on a 12-year-old boy's left lower eyelid began to grow rapidly on the inside of the lid. A fleshy, red, sessile conjunctival mass with a palpable rigid, nontender lesion was noted on the eyelid.

This mass is a pyogenic granuloma of the conjunctiva that developed in response to an underlying chalazion. Pyogenic granuloma of the eyelid may be seen after trauma or surgery or may form over inflammatory lesions. These nodules have occurred rarely in the anophthalmic socket following enucleation of the eye and at the margin of corneal transplants.

Microscopically, a pyogenic granuloma is composed of granulation tissue with chronic inflammatory cells, fibroblasts, and endothelial cells of budding capillaries. Since the lesion is neither pyogenic nor granulomatous, the term pyogenic granuloma, which was coined by M. B. Hartzell in 1904,¹ is actually a double misnomer.

Treatment consists of complete excision and curettement of the underlying chalazion. Pathologic evaluation also is recommended, since several other benign and malignant neoplasms, such as Kaposi's sarcoma, may simulate pyogenic granuloma.

In rare cases, pyogenic granuloma may continue to grow or recur following treatment. In this setting, low-dose brachytherapy with a radioactive plaque has been effective.

REFERENCE:1. Griffith DG, Salasche SJ, Clemons DE. Cutaneous Abnormalities of the Eyelid and Face: An Atlas With Histopathology. New York: McGraw-Hill; 1987:136-137.