Local corticosteroid treatment of eyelid and orbital xanthogranuloma

Purpose: To demonstrate the efficacy of local corticosteroid therapy for the treatment of eyelid and orbital xanthogranuloma in adults. Methods: We performed a retrospective chart review of six patients receiving local triamcinolone acetonide (40 mg/mL) injections for the treatment of eyelid and orbital xanthogranuloma at the University of Michigan. All patients underwent diagnostic biopsy prior to treatment. The effects of this therapy on symptoms and signs of the disease were assessed. Results: All six patients complained of eyelid swelling or nodularity, and five had yellow discoloration of their eyelids. All lesions involved the eyelids and anterior orbit, and five were present bilaterally. Biopsy revealed necrobiotic xanthogranuloma in four patients and adult-onset xanthogranuloma in two patients. Triamcinolone acetonide was administered intralesionally as series of two to 25 injections. Local control was obtained in all six cases, with the reduction of symptoms and signs of the disease in five cases. Two patients with necrobiotic xanthogranuloma developed non-Hodgkin's lymphoma. Average follow-up of patients whose treatment was not truncated by systemic chemotherapy was 52 months (range, 30 to 86 months). No complications occurred as a result of this treatment. Conclusion: Intralesional injection of triamcinolone acetonide is an effective, safe treatment for orbital xanthogranuloma in adults. This modality avoids the side effects associated with systemic corticosteroid or cytotoxic agent therapy.