Derick Mussen Preventive Healthcare

Dermolipoma

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INTRODUCTION The dermolipomas are congenital choristomas that typically occur on the superotemporal conjunctiva. They contain more adipose tissue that the solid dermoid, and are more common in patients with Goldenhar syndrome (oculoauriculovertebral dysplasia). When they contain variable combinations of ectopic tissues such as cartilage, smooth muscle, and acinar glands, they are referred to as complex choristomas. Dermolipomas account for about 5% of all conjunctival tumors in childhood.

CLINICAL PRESENTATION Dermolipomas usually present in childhood and occur in the superotemporal conjunctiva. They can extend onto the corneal surface or posteriorly into the fornix or even into the orbit. They are well-defined, elevated pink to yellowish, fatty lesions that may contain fine telangiectasias. Hair can grow from these lesions resulting in corneal abrasion. When large they can irritate the palpebral conjunctiva inciting a papillary conjunctivitis.

HISTOPATHOLOGY Dermolipomas are composed of mature adipose tissue and bundles of dense collagenous tissue. Hair follicles and adnexal glands are usually absent. The conjunctival epithelium may be irregularly thickened, or it may be thin and smooth.

DIFFERENTIAL DIAGNOSIS The differential diagnosis includes prolapsed orbital fat, dermoid cysts, and conjunctival tumor.

TREATMENT Treatment is indicated for cosmesis or for symptoms related to corneal exposure from eyelid displacement away from the globe. When removal is desired a simple lamellar dissection is appropriate for the corneal portion. For the remainder of the lesion conjunctival resection should be kept to a minimum and only that portion of the tumor anterior to the orbital rim should be removed. Care must be taken to avoid injury to the lateral rectus muscle insertion and the ductules of lacrimal secretion. Complications include damage to the lacrimal secretory system, restrictive strabismus, diplopia, and sympblepharon formation.

REFERENCES

Beard C. Dermolipoma surgery, or, "an ounce of prevention is worth a pound of cure." Ophthal Plast Reconstr Surg 1990; 6:153-157.

Beby F, Kodjikian L, Roche O, et al. Conjunctival tumors in children. A histopathologic study of 42 cases.

J Fr Ophtalmol 2005; 28:817-823. D'Hermies F, Saragoussi JJ, et al. Limbal dermoid and Goldenhar syndrome. Report of an anatomical study. J Fr Ophthalmol 2001; 24:893-896.

Francoise P, Lekieffre M, Woillez M, Ryckewaert M. Complications of dermolipoma ablation. Bull Soc Ophtalmol Fr 1989; 89:289-290.

Fry CL, Leone CR Jr. Safe management of dermolipomas. Arch Ophthalmol 1994; 112:1114-1116. Kamali K, El-Rifai. Dermolipoma adherent to the lacrimal gland. Bull Ophthalmol Egypt 1975; 68:633-636. Kim YD, Goldberg RA. Orbital fat prolapse and dermolipoma: two distinct entities. Korean J Ophthalmol 1994; 8:42-43. Manners RM, Vardy SJ, Rose GE. Localized giant papillary conjunctivitis secondary to a dermolipoma. Eye 1995; 9:376-378. McNab AA, Wright JE, Caswell AG. Clinical features and surgical management of dermolipomas. Aust N Z J Ophthalmol 1990; 18:159-162.

Touzri RA, Beltaief O, Romdhane BB, Kriaa L, Ouertani AM. Complications of dermolipoma surgery. Two observations. J Fr Ophtalmol 2004; 27:1156-1158.