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| CLINICAL IMAGE |
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| Year : 2022 | Volume
: 15
| Issue : 3 | Page : 419-420 |
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A sporadic case of orbital grease gun granuloma
Rutuja Malekar, Kirthi Koka
Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya Medical Research Foundation, Chennai, Tamil Nadu, India
| Date of Submission | 15-May-2021 |
| Date of Decision | 25-Oct-2021 |
| Date of Acceptance | 29-Mar-2022 |
| Date of Web Publication | 02-Nov-2022 |
Correspondence Address:
Kirthi Koka
Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya Medical Research Foundation, 18, College Road, Nungambakkam, Chennai, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ojo.ojo_150_21
 Abstract | | |
Keywords: Grease granuloma, grease gun injury, penetrating injury
How to cite this article:
Malekar R, Koka K. A sporadic case of orbital grease gun granuloma. Oman J Ophthalmol 2022;15:419-20 |
A 21-year-old male presented to our clinic with complaints of diminution of vision, redness, and prominence of the right eye (RE) after sustaining an injury with a grease gun in a factory 1 month ago. Since then, his best-corrected visual acuity (BCVA) was 6/36 with restricted extraocular movements in the RE. BCVA in the left eye was 6/6 with full extraocular movements. On examination, he had right lower eyelid superficial abrasions, conjunctival chemosis, caruncular edema along with 9 mm axial proptosis, and grossly raised retrobulbar resistance [Figure 1]a. The pupil was sluggishly reacting to light with no relative afferent pupillary defect. Intraocular pressure was 16 mmHg and fundus examination showed a full-thickness macular hole. | Figure 1: (a) Site of entry of the grease (arrow) with gross axial proptosis. (b) Computed tomography image, axial view showing a right-sided hypodense retrobulbar lesion surrounded by hyperdense rim signifying grease foreign body, compressing and displacing the optic nerve nasally
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Computed tomography (CT) scan of the orbit showed a lobulated, hypodense lesion in the right inferolateral retrobulbar space with a hyperdense rim, temporal to the optic nerve and displacing the nerve medially [Figure 1]b. The density of the lesion was equivocal to fat, suggestive of grease. RE wound exploration was performed under general anesthesia. Cyst cavity was identified, opened, and the grease inside was prolapsed and removed [Figure 2]a. Granulation tissue surrounding the cystic cavity was sent for histopathological examination. It showed multiple lipid vacuoles with foreign body granulomatous inflammation, suggestive of grease granuloma [Figure 2]b. | Figure 2: (a) Intraoperative picture showing removal of the grease foreign body. Inset showing removed grease and granuloma cyst wall. (b) Histopathology specimen (H and E, ×40) showing multiple lipid vacuoles (arrow) surrounded by histiocytes and multinucleate giant cells with focal neutrophils
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Postoperatively on day 5, he was doing well and his BCVA improved to 6/18 in the RE. He is awaited for further follow-up.
| Discussion | |  |
Grease is a thixotropic substance which is commonly used under pressure as a lubricant in factories. It remains in the solid state at rest but when agitated, it liquifies.[1],[2] Grease-gun injuries are typically high-velocity and high-pressure injuries leading to penetrating trauma with deceptively small entry wounds. Post injury patients often present with defective vision, pain, proptosis, decreased ocular motility, diplopia, and skin lacerations.[1],[2],[3] CT scan is less efficacious to detect grease since it is isodense to fat. On T1-weighted magnetic resonance imaging, grease appears as a high-intensity signal surrounded by a low-signal rim signifying the surrounding granulomatous inflammation.[3] Grease oil granuloma shows a typical Swiss cheese appearance on histopathology, with cystic spaces filled with lipid material and surrounding granulomatous inflammation marked by lymphocytes, epithelioid cells, and multinucleate giant cells.[3] Pathological features mimic liposarcoma which can be ruled out with a good clinical history.[4]
The management consists of immediate surgical debridement to thwart any inflammatory reaction in future and orbital tissue biopsy to confirm the diagnosis. Grease oil presenting as a foreign body granuloma is a unique presentation and only eight cases have been published in the literature to date.[1] The first such case was published in 1964.[5] This case is the ninth case worldwide and the second case in India. Thus, clinicians should be cognizant of grease oil granuloma as a differential diagnosis in patients with grease-gun injury to the orbit.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has/have given her consent for her images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Chakraborti C, Saha AK. Grease gun injury of the orbit: A rare case report. Indian J Ophthalmol 2020;68:1701-3.  [ PUBMED] [Full text] |
| 2. | Gekeler F, Cruz AA, de Paula SA, Dos Santos AC, Chahud F. Intraconal grease-gun injury: A therapeutic dilemma. Ophthalmic Plast Reconstr Surg 2005;21:393-5. |
| 3. | Wang Y, Lu X, Xiao L. Delayed presentation of grease-gun injury to the orbit. Ophthalmic Plast Reconstr Surg 2008;24:154-6. |
| 4. | Cheema M, Roelofs K, Jivraj I, West R, Rasmussen S, Chan A. A rare case of orbital granulomatous inflammation from explosive hydraulic oil masquerading as orbital cellulitis. Orbit 2018;37:154-6. |
| 5. | Dallas NL. Chronic granuloma of the orbit caused by grease-gun injury. Br J Ophthalmol 1964;48:158-9. |
[Figure 1], [Figure 2]
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