Abstract
Subconjunctival fat herniation is rarely described in the literature, but it is common in clinical practice. It represents prolapse
of the intraconal fat to the subconjunctiva, mainly from aging. It usually occurs in the superotemporal quadrant of the globe,
and rarely causes symptoms. Microscopically, multinucleated giant cells that frequently have a floret-like appearance (floretlike
cells), and also bizarre adipocytes with nuclear vacuoles (Lochkern cells) are seen. We present a case of a 68-year-old
Japanese man with subconjunctival fat herniation that showed floret-like cells and Lochkern cells. The differential diagnosis included
lipomatous tumors of the orbit such as pleomorphic lipoma, liposarcoma, as these resemble subconjunctival fat
herniation macroscopically. It is important to make a histopathological diagnosis for fat herniation to avoid overlooking malignant
tumors and over-treating benign lesions.
