A 67-year-old male presented with a history of swelling in the lateral canthi of both eyes for the last 4–5 years. No associated history of redness, watering, or difficulty in vision. Additionally, there was no restriction of movement in the extraocular muscles. Clinically, the epibulbar swellings were nearly symmetrical, glistening yellowish with no vascularity therein Figure 1a. Magnetic resonance imaging (MRI) of the brain and orbits revealed elongated soft tissue lesions with fat signal intensity in the superolateral aspect of both the orbits, contiguous with the intraconal fat and devoid of any differential signal intensities or calcifications within Figure 1b-e. Cervico-cranial neuroparenchyma and vascular flow voids were normal.Figure 1: Bilateral epibulbar lateral canthal fatty swelling in both eyes as seen clinically (a), coronal MRI of T1 without fat saturation (b) and with fat saturation (c) as well as axial sections of T2 (d) and T1 (e) showing bilateral superolateral subconjunctival fat prolapse (arrows in b, c, d, e) that is contiguous with the intraconal fat. MRI = Magnetic Resonance ImagingSubconjunctival fat prolapse (SCFP) is a focal intraconal fat herniation due to an acquired weakening of the Tenon's capsule and intermuscular septum associated with the age-related degenerative process.1 It is mostly seen in elderly obese men of 65–72 years as bilateral epibulbar lateral canthal yellowish mobile masses.2 Although largely asymptomatic, clinical features may simulate conditions such as a prolapsed lacrimal gland, orbital lymphoma, or dermolipoma and may worsen over time.3 MRI is important for diagnosis by establishing the fat signal within the contents without any radiation risks. Dermolipoma, a mimicker on imaging, clinically presents as a non-mobile epibulbar mass early in life. Also, dermolipoma lies anterior to the insertion of the lateral rectus muscle and medial to the lacrimal gland, without connection to the intraconal fat. The characteristic MR findings with fat-saturated sequences help differentiate SCFP from dermolipoma and guide appropriate corrective surgery when indicated.4 Abbreviations Subconjunctival fat prolapse = SCFP Magnetic resonance imaging = MRI Declaration of patient consent The patient has provided informed consent for publication of the case. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Lamichhane et al. (Tue,) studied this question.