Letter to the Editor
Silicone Migration: An Unusual Eyelid
Complication Following Intraocular Surgery
Aesthetic Surgery Journal
2016, Vol 36(1) NP20–NP22
© 2015 The American Society for
Aesthetic Plastic Surgery, Inc.
Reprints and permission:
journals.permissions@oup.com
DOI: 10.1093/asj/sjv155
www.aestheticsurgeryjournal.com
Tammy H. Osaki, MD, PhD; Midori H. Osaki, MD;
Norma Allemann, MD, PhD; and Teissy Osaki, MD
Accepted for publication July 10, 2015; online publish-ahead-of-print August 7, 2015.
Ultrasound imaging is not traditionally employed to evaluate eyelid lesions. Nevertheless, this technology permits the
delineation of static and dynamic changes and could be
useful in evaluating eyelid masses by providing additional
information to clinicians for optimal surgical planning,
especially in facilities where a computed tomography (CT)
scan is not readily available.
A 63-year-old woman presented in April 2014 with a
painless mass in the right upper lid (RUL) associated with
ptosis (Figure 1A) that had gradually developed during the
previous 10 months. Retinopexy associated with vitrectomy
with intraocular silicone oil filling was performed 15 months
before to treat a retinal detachment in the right eye. Silicone
oil was removed 8 months later. For the past 4 months,
patient was under investigation for a breast nodule.
Marginal reflex distance (MRD-1) was −1 on the right
and +3 on the left side. Levator function was 13 and 15 mm.
Best corrected visual acuity was counting fingers 2 m and
20/20. Fundoscopy in right eye did not permit periphery
evaluation due to poor dilation. The remainder of the ophthalmological examination revealed no abnormalities.
Differential diagnosis of a noninflammatory eyelid
lesion includes benign and malignant tumors, eyelid metastasis, and vascular lesions. Since the patient had a
history of a breast nodule, an eyelid metastatic lesion had
to be ruled out. While we waited for CT scan, ultrasound
examinations were performed. Ultrasound biomicroscopy
(UBM) showed cystic formations with anechoic content
underneath the muscular layer of the RUL. There was significant attenuation of the posterior structures, ruling out
hematic, serous, or purulent content (Figure 2B,C). B-scan
ultrasonography was next performed and showed a hypoechoic space in the RUL-containing material causing sound
attenuation and an artificial lengthening of the echogram,
suggesting the presence of a substance with a lower speed
of sound propagation compared with the vitreous (Figure 2A).
B-scan thus ruled out a tumor or a metastatic lesion but not
Figure 1. (A) This 63-year-old woman presented with a painless mass in the right upper eyelid associated with upper lid
ptosis that had gradually developed for 10 months. (B) Final
aspect 1 year after excision of the mass and reinsertion of the
levator aponeurosis to the tarsus.
a low-flow vascular lesion. Doppler examination showed a
cystic and lobulated lesion, and flowmetry did not depict any
internal blood flow, ruling out a vascular lesion (Figure 2D).
From the Department of Ophthalmology and Visual Sciences, Federal
University of Sao Paulo/UNIFESP, Sao Paulo, SP, Brazil.
Corresponding Author:
Dr Tammy H. Osaki, Ophthalmic Plastic Surgery Division, Department
of Ophthalmology and Visual Sciences, Federal University of São
Paulo, Botucatu St, 821, 2nd Floor. São Paulo, SP 04023-062, Brazil.
E-mail: tammyosaki@me.com
Osaki et al
Figure 2. (A) Standard echography of the right upper eyelid
showing a hypoechoic space in the upper eyelid containing
material that caused sound attenuation and an artificial lengthening of the echogram, suggesting the presence of a substance
with a lower speed of sound propagation than the vitreous
speed. (B, C) Ultrasound biomicrospy showing cystic formations with anechoic content underneath the muscular layer of
the upper eyelid. A significant attenuation of the posterior
structures could be observed. (D) Color Doppler ultrasound
showing an anechoic (cystic) and lobulated lesion; flowmetry
did not depict any internal blood flow. (E) Macroscopic view
of the eyelid mass excised. It was located within the levator
muscle layer. (F, G) Histopathology of the mass revealed pseudocysts surrounded by variable degrees of fibrosis within a fat
tissue and a mild chronic inflammatory infiltrate (hematoxylin
eosin; magnification ×200; ×100).
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blepharoplasty was performed. The aforementioned mass
was located within the levator aponeurosis layer and presented a clear color and hardened consistency (Figure 2E),
yet was not entirely removed due to its extremely posterior
location. After the removal of the mass, levator aponeurosis
was reinserted into the tarsus. One month after surgery,
the patient reported no complaints and MRD-1 was +3
in the right eye. One-year follow-up showed no recidivism
of the lesion (Figure 1B).
Histopathology examination revealed a well-delimited
mass with internal pseudocysts surrounded by variable
degrees of fibrosis within a fat tissue and a mild chronic
inflammatory infiltrate (Figure 2F,G). These findings associated with history and imaging highly suggested that the
pseudocysts were previously filled with silicone oil.
CT scan is usually the most used imaging technology to
evaluate an eyelid lesion, since it permits evaluating the
extent of lesion invasion. However, this technology is
associated with ionizing radiation and higher cost, and
evaluation usually requires use of contrast. Ultrasound
technologies, on the other hand, are noninvasive, do not
involve ionizing radiation, and permit observation of the
morphology of a lid lesion as well as the identification of vascular patterns.1 UBM is a noninvasive imaging modality that
allows in situ cross-sections with microscopic resolution.2
UBM’s usefulness in the diagnosis and management of anterior segment abnormalities is well known;2,3 however, few
studies analyzed this modality to evaluate eyelid lesions.1
Although UBM and Doppler may not be applicable to the
average practitioner, B-scan ultrasonography is present in
most facilities, is much cheaper than CT, and was useful to
rule out a solid lesion in our case.
This patient was under investigation regarding a breast
nodule. Though metastasis of the eyelids accounts for <1%
of all malignant lesions, when they do occur, the most
common primary tumor is breast carcinoma.4
The presence of silicone oil in eyelid tissues after intraocular surgery is uncommon; nonetheless, it should be
considered as a differential diagnosis for patients submitted
to intraocular surgery. Anterior migration of oil that leaked
after vitreoretinal surgery and reached the eyelid is the
most likely explanation.5
Ultrasound imaging may be helpful in investigating the
etiology of an eyelid mass. Ultrasound technologies may facilitate surgical planning by providing information about
the anatomic field, morphologic features, dimensions, and
perfusion.
Acknowledgments
Orbit CT scan with contrast showed hyperdense, lobulated
lesions in RUL topography without any signs of infiltration.
A combined excisional biopsy and exploration of
the levator aponeurosis associated with bilateral upper
The authors would like to acknowledge the Ophthalmic
Histopathology Division at the Federal University of Sao Paulo
and Marcia Lowen, MD, in particular, for providing the histopathology slides.
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Disclosures
The authors declared no potential conflicts of interest with
respect to the research, authorship, and publication of this
article.
Funding
The authors received no financial support for the research,
authorship, and publication of this article.
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Aesthetic Surgery Journal 36(1)
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