Sclerosing lipid granuloma of the medial canthus 30 years after dacryocystitis.

Editor,—Lipid granuloma of the lid and anterior orbit can occur in various conditions.1-6 We present a 33 year old woman with an indurated inflammatory swelling at the medial canthus 30 years after a dacryocystitis on the same side. Histologically the lesion was identical to those that have been described as a reaction to paraffin from displaced ointments.7 The lipid in our case, however, was analysed as a mixture of triglycerides corresponding to a substance that was previously used as a contrast material for dacryocystography. To our knowledge, this is the longest time span reported to date between the application of a lipid based material and the development of a lipogranulomatous reaction. ### CASE REPORT A 33 year old white woman presented with a painless red swelling of the medial left lower lid (Fig 1A) that had been present for several weeks. There was an obstruction of both lower and upper canaliculus and also mild oedema of the upper lid. On palpation, the swelling presented as a remarkably firm subcutaneous mass extending deep into the medial canthal area. Otherwise, all ocular findings were normal. The patient's previous ocular history was unremarkable apart from a left sided refractory dacryocystitis at age 3 that had been investigated and …