Orbital Cholesterol Granuloma – A Rare Case Report and Discussion

Cholesterol granuloma is an uncommon chronic foreign-body inflammatory response that is seen in the mastoid antrum, petrous apex, and the middle ear, also occurring in rarer anatomical locations such as the orbit. A 37-year-old male presented with watering and heaviness in the left eye, with radiological imaging revealing a well-defined extraocular lesion in the superolateral part of the left orbit. The pathogenesis of this uncommon cystic condition is not known, but trauma and excision of air through pneumatized temporal bone air cells have often been the culprits. Microscopy revealed mainly cholesterol clefts, a focus of calcification, and hemosiderin-laden macrophages. Treatment involves excision of the lesion and removal of the residual adherent tissue to minimize recurrence. Cholesterol granulomas usually have a good prognosis.