Supplementary Material for: Cholesterol Granuloma of the Orbit Presenting with Gaze Amaurosis – A Case Report

Histopathology demonstrated cholesterol clefts surrounded by foamy histiocytes, multinucleated giant cells, and hemosiderin-laden macrophages, confirming diagnosis of cholesterol granuloma. Cultures were positive for Propionibacterium acnes and Staphylococcus species, for which the patient completed a short course of oral antibiotics. Postoperatively, visual symptoms resolved immediately, and no recurrence was observed over six months.

Conclusion: This is the first reported case of orbital cholesterol granuloma presenting with gaze-evoked amaurosis. Although these lesions usually cause progressive proptosis, they may rarely produce transient, gaze-dependent visual symptoms due to localized compressive effects. Complete surgical excision via an eyelid crease approach results in excellent outcomes with minimal recurrence risk and should be considered the treatment of choice.