Tetracycline
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First report of eyelid paraffinoma: case report A 64-year-old woman developed eyelid paraffinoma following treatment with tetracycline. The woman, who had a history of impaired vision in the left eye since childhood, underwent endoscopic endonasal sinus surgery in September 2006 for chronic sinusitis. During surgery, the thin lamina papyracea was perforated, and 13 sheets of gauze with tetracycline ointment [dosage not stated] were packed into the ethmoidal sinus and nose. She developed left eyelid swelling several hours after surgery. The woman was treated with betamethasone and piperacillin. Her eyelid swelling gradually decreased, and the gauze packing was removed on postoperative day 5. Two days later, the swelling had almost completely resolved. Seven days after discharge, she returned to the clinic and reported that the swelling had returned 5 days earlier. Due to suspected infection-induced oedema, she received a 12-day course of prednisolone. An ultrasound of the eyelid revealed a 4.7mm band-like cystic area under the skin of the upper eyelid. Multiple mass lesions were seen on an MRI. An upper eyelid biopsy revealed a number of masses between the subcutaneous layer and the orbital septum, each consisting of a gelatinous substance resembling ointment. The definitive diagnosis was paraffinoma due to a foreign body reaction to tetracycline ointment. The masses were surgically removed in April 2007. Three months later, an MRI showed a small amount of remaining foreign matter. At last follow-up, her eyelid contracture was improving, with no recurrence of paraffinoma. Hasegawa T, et al. A case of eyelid paraffinoma that developed after endoscopic sinus surgery. Auris Nasus Larynx 38: 538-42, No. 4, Aug 2011 803061737 Japan
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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of paraffinoma associated with tetracycline. The WHO ADR database did not contain any reports of lipogranuloma associated with tetracycline.
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Reactions 22 Oct 2011 No. 1374
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