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: The authors performed a retrospective chart review of 6 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 before treatment. The effects of this therapy on symptoms and signs of the disease were assessed. Results: All 6 patients had eyelid swelling or nodularity and 5 had yellow discoloration of their eyelids. All lesions involved the eyelids and anterior orbit and 5 were present bilaterally. Biopsy revealed necrobiotic xanthogranuloma in 4 patients and adult-onset xanthogranuloma in 2 patients. Triamcinolone acetonide was administered intralesionally as series of 2 to 25 injections. Local control was obtained in all 6 cases, with the reduction of symptoms and signs of the disease in 5 cases. Two patients with necrobiotic xanthogranuloma had development of non-Hodgkin 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. Conclusions: 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.