Citation

Malekar R, Koka K. Oman J. Ophthalmol. 2022; 15(3): 419-420.

Copyright

(Copyright © 2022, Oman Ophthalmic Society, Publisher Medknow Publications)

DOI

10.4103/ojo.ojo_150_21

PMID

36760920

PMCID

PMC9905905

Abstract

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 1a]. 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.

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]

Language: en

Keywords

Grease granuloma; grease gun injury; penetrating injury