INTRODUCTION Prolapse of extraconal orbital fat into the eyelids is a common finding generally related to aging phenomena. The fat pockets bulge forward behind a lax orbital septum. That condition is known as steatoblepharon. Prolapse of intraconal orbital fat beneath the conjunctiva is a different phenomenon that presents as a subconjunctival mass rather than a swelling of the eyelid. It may be related to trauma, prior eyelid surgery, and has been associated with diseases such as cutis laxa (generalized elastosis). Most often, however, it is seen as an idiopathic condition. It may occur through a dehiscence in Tenon's capsule or the fat can extend into the cowl of Tenon's capsule that extends along an extraocular muscle to its insertion on the sclera. While most patients are older adults, this can be seen in teens and children as well.
CLINICAL PRESENTATION Prolapse of orbital fat is almost always seen superotemporally where the fat protrudes beneath the lateral part of Whitnall's ligament and palpebral lobe of the lacrimal gland. A soft yellowish-white fat lobule is seen beneath the bulbar conjunctiva just adjacent to the insertion of the lateral rectus muscle or sometimes over it. When small, the lesion may not be visible unless the lid is pulled upward so that the patient may no be aware of it. However, with larger lesions the fat is visible within the palpebral fissure. There is no associated pain or inflammation, and these lesions are usually of cosmetic concern only. Rarely with very large lesions, corneal dryness and even dellen formation can be seen when the lid is lifted off the corneal surface. This condition can be unilateral or bilateral.
TREATMENT These lesions usually do not require treatment except for cosmetic improvement or when causing corneal exposure. They are easily removed through a conjunctival incision with excision of the prolapsing portion of the fat lobule. Care should be taken not to injure the lateral rectus muscle insertion.
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