Ocular Surface Granuloma Faciale: A Clinicopathologic Study of Two Novel Conjunctival Cases with a Review of the Literature Regarding Ophthalmic Involvement.

Granuloma faciale (GF) is a rare, idiopathic, localized vasculitis, usually without associated systemic autoimmune disease. Primarily involving the skin, GF can also occur on the ocular surface, mimicking neoplasia and other inflammatory processes. In this report, the authors report 2 novel cases of GF in the conjunctiva, and analyze the 4 published ocular cases to better appreciate the clinical and histopathologic features of GF involving the ocular surface, and to compare the findings with those in the skin. A pink-to-yellowish lesion of the superior bulbar conjunctiva in a 16-year-old female and a flesh-colored lesion of the superior tarsal conjunctiva in a 47-year-old female are described, with clinical concern for a lymphoproliferative or granulomatous disease. Conjunctival biopsies were performed. In both cases, microscopic examination revealed a neutrophil-rich, mixed inflammatory infiltrate including eosinophils and plasma cells with focal leukocytoclastic vasculitis and varying degrees of fibrosis, in areas showing a perivascular onion-skinning appearance. Special stains did not detect microorganisms, and immunohistochemical studies, including those for IgG4 and Fos-B, also showed no significant staining. Neither patient displayed skin involvement, nor was an associated systemic autoimmune disease detected after laboratory testing. No specific therapy was given, and there was no recurrence at the time of this report. GF may occur in the ocular adnexa. Biopsy is essential for making a diagnosis of GF, with histopathologic findings very similar to those seen in the skin.