Pyogenic granuloma is a common, benign vascular lesion that can develop on various parts of the body. While often found on the skin or mucous membranes, these growths can also appear in the eye region. This condition, though generally harmless, can cause discomfort and concern due to its rapid growth.
What is Pyogenic Granuloma of the Eye?
Pyogenic granuloma of the eye is a non-cancerous growth primarily composed of numerous tiny blood vessels. It is more accurately termed a “lobular capillary hemangioma,” as it is neither pus-producing nor a true granuloma. The lesion typically presents as a reddish, raised bump, often with a smooth, shiny, or friable (easily bleeding) surface.
These growths can range in size from a few millimeters to several centimeters and often develop a scaly, white “collar” at their base. They can attach directly to the tissue or be connected by a stalk-like structure. In the ocular region, pyogenic granulomas commonly appear on the conjunctiva (the clear membrane lining the inside of the eyelids and covering the white part of the eye), eyelids, and rarely, on the cornea or within the orbit.
Common Causes and Triggers
The exact cause of pyogenic granuloma in the eye is not always clear, but several factors contribute to its development. It is essentially an exaggerated healing response where the body produces an overgrowth of blood vessel tissue. Minor trauma or injury is a frequent trigger, including eye rubbing, the presence of a foreign body, or insect bites.
Chronic irritation, such as long-term contact lens wear or stitches from previous eye surgeries (e.g., strabismus surgery, scleral buckle procedures), can also promote their formation. Inflammation, like that caused by chronic conjunctivitis or a stye, can initiate the growth of new blood vessels. Hormonal changes, particularly during pregnancy, are another recognized trigger, leading to increased vascularity and tissue fragility in the eye region. Certain medications, including some topical or systemic agents that affect blood vessel growth, like prostaglandins or retinoids, have also been linked to pyogenic granuloma development.
Recognizing the Signs
A person with pyogenic granuloma of the eye might observe a reddish lump on or around their eye. This growth can be pink, red, or even purplish, and its surface may appear smooth or, if it has bled, become crusty or rough. The lesion can cause redness and swelling in the affected eye, leading to discomfort or the sensation of a foreign body. Occasional bleeding from the lesion is common, even with minimal contact.
While generally not painful, a pyogenic granuloma can interfere with normal blinking, potentially causing dry eye symptoms. Larger lesions or those located on the cornea can physically obstruct vision or induce astigmatism, making objects appear wavy. Any new or persistent growth in the eye area warrants prompt professional medical evaluation to ensure an accurate diagnosis and appropriate management.
How It Is Diagnosed
Diagnosing pyogenic granuloma of the eye begins with a thorough clinical examination by an ophthalmologist. The doctor will review the patient’s medical history, including any recent trauma, surgeries, or chronic eye conditions. A visual inspection of the eye is performed, often followed by an examination using a slit lamp, a specialized microscope that allows for a magnified view of the eye’s structures.
While the lesion’s appearance is often sufficient for a presumptive diagnosis, further steps may be taken. To confirm the diagnosis and rule out other conditions that might mimic a pyogenic granuloma, such as squamous cell carcinoma or other vascular lesions, a biopsy might be performed. This involves taking a small tissue sample for histopathological examination, which provides a definitive diagnosis by revealing the lesion’s microscopic structure.
Treatment Options
Treatment for pyogenic granuloma of the eye varies based on the lesion’s size, location, and symptoms. For very small, asymptomatic lesions, observation might be recommended, as some can spontaneously regress over several weeks to months. However, if the lesion causes discomfort, bleeding, or affects vision, intervention is generally advised.
Surgical excision is the most frequent method for removal, involving complete removal of the growth, sometimes followed by cauterization of the base to minimize recurrence. This method also provides a tissue sample for pathological examination, confirming the diagnosis and excluding malignancy. Other treatment modalities include laser therapy, which uses focused light to remove the granuloma, and cryotherapy, which involves freezing the lesion to destroy the abnormal tissue.
Topical medications are also utilized, such as corticosteroids to reduce inflammation and beta-blockers like timolol, which can help shrink the lesion by affecting blood vessel growth. Recurrence is possible after treatment, especially if the lesion is not completely removed, with rates varying depending on the method used; surgical excision and cryotherapy generally have lower recurrence rates, around 1.62% to 2.94%. Therefore, follow-up care with an ophthalmologist is important to monitor for any regrowth or new lesions.