Lacrimal ductal cysts. Presentation and management

doi:10.1016/0039-6257(86)90120-7

Survey of Ophthalmology

Volume 30, Issue 4, January–February 1986, Pages 245-250

https://doi.org/10.1016/0039-6257(86)90120-7 Get rights and content

Abstract

The authors have reviewed the clinical and histopathologic features of nine cases of lacrimal ductal cysts. Six of these were proven histologically, and three were diagnosed clinically. All presented as masses, three with pain, five with tenderness and two with acute expansion due to hemorrhage in one case and following crying and deep sea diving in the other. Six were treated surgically and three are being followed clinically. The six lesions examined histologically were all ductal cysts with evidence of scarring and inflammation. The differential diagnosis and management are outlined.

References (6)

A Rush et al.
Ectopic lacrimal gland cyst of the orbit
Am J Ophthalmol
(1981)
DK Sen et al.
Simple dacryops
Am J Ophthalmol
(1967)
S Duke-Elder et al.

There are more references available in the full text version of this article.

Cited by (48)

Infantile simple dacryops: clinicopathological correlation and immunocharacterization
2020, Journal of AAPOS
Citation Excerpt :
Surgery is indicated in symptomatic patients, for cosmetic concerns, and to prevent amblyopia due to mechanical ptosis in children, as in our case. Incomplete surgical removal, puncture, and aspiration can cause recurrence, fistula formation, and secondary tear deficiency due to destruction of lacrimal gland tissue.4,8,9 Marsupialization of the cyst has also been described10 and is believed to be a safe surgical intervention that attempts to spare the lacrimal ductules.
Simple dacryops is a cystic lesion of the ductal structures of the palpebral lobe of the lacrimal gland and is the commonest lacrimal ductal cystic lesion in adults. We report the case of an 18-month-old girl with a painless swelling of the right temporal upper eyelid that was first noted at 4 months of age. An early surgical excision was planned to avoid deprivational amblyopia. We describe clinicopathological and immunohistochemical correlations in our case, highlighting the immuno-characterization of adjacent lacrimal gland duct and acinar structures present within the cyst wall and management of this relatively rare entity.
The cytologic composition of dacryops: An immunohistochemical investigation of 15 lesions compared to the normal lacrimal gland
2013, American Journal of Ophthalmology
Citation Excerpt :
What is the nature of the inner cells of the double layer constituting the dacryops’ epithelial lining? From time to time, ophthalmic articles on dacryops have mentioned en passant the presence of “snouts” on the apical adlumenal membranes of the inner cells of the dacryops’ epithelial lining.9,13 A recent publication in a highly respected cutaneous pathology journal on 6 cases of dacryops expatiated on this subject, and equated such cytoplasmic expansions or projections seen in all dacryops lesions with true decapitation secretion of cells that had transformed into apocrine cells, which was postulated to be a frequent occurrence in dacryops.33
To define the cytologic composition of the double-layered epithelial lining of dacryops (lacrimal duct cyst), improve histopathologic diagnosis, and better understand pathogenesis.
Clinicopathologic retrospective study with immunohistochemical studies of 15 lesions compared with normal lacrimal gland.
Clinical data from 14 patients were reviewed and microscopy was performed with routine stains and immunohistochemical probes for epithelial membrane antigen (EMA), gross cystic disease fluid protein-15 (GCDFP-15), cytokeratin 7 (CK7), and smooth muscle actin (SMA).
The major lacrimal gland was involved in 13 lesions; 2 lesions arose in an accessory gland of Krause. One case was bilateral; the average age of the patients was 50.7 years. Neither visual acuity nor motility was disturbed. No lesion was discovered to have recurred after excision. Microscopically, in all dacryops specimens goblet cells and luminal pseudoapocrine apical cytoplasmic projections were identified. Lacrimal acinar cells immunoreacted with GCDFP-15 and CK7, whereas the normal ducts and the epithelium of the dacryops lesions reacted diffusely only with CK7. SMA-positive myoepithelial cells were found in the acini but not in the normal ducts or dacryops epithelium.
Negative GCDFP-15 staining ruled out apocrine metaplasia in dacryops. Normal ducts and dacryops showed no immunohistochemical evidence for the presence of myoepithelial cells. Pathogenetic theories of dacryops that implicate a failure of ductular “neuromuscular” contractility must therefore be revised. A dysfunction of the rich neural plexus around the ductules may play a role in the development of dacryops in conjunction with periductular inflammation and induced scarring.
Developmental conjunctival cyst of the eyelid in a child
2012, Journal of AAPOS
Complex Palpebral Odontogenic Choristoma: A Reappraisal of the Origin of Teeth-bearing Periocular Lesions
2009, American Journal of Ophthalmology
Citation Excerpt :
A report38 of 3 nonkeratinizing and non-ciliated anteromedial orbital cysts with scattered goblet cells, in the absence of any appendageal structures in the cysts' wall and of any bony dehiscenses, concluded that the lesions were respiratory ectopias, but most probably they were conjunctiva-derived cysts, either congenital or acquired.39–41 Duct cysts of the major and minor lacrimal glands (dacryops) are lined by nonciliated, cuboidal to low columnar epithelium evincing scattered goblet cells with lobules or acini of lacrimal secretory tissue in intimate relationship to the cyst.42–44 Some observations should be offered on the management of this case.
To describe the findings observed in a congenital ectopic tooth of the lower inner eyelid and explain its origin.
Retrospective and interventional clinicopathologic study.
Histopathologic evaluation of sequentially excised specimens over 4 years and radiographic study of any associated dental abnormalities, compared with critical reevaluation of similar reported cases in the literature.
The ectopic eyelid tooth clinically created a dome-shaped mass and microscopically displayed advanced cytodifferentiation but incomplete morphogenesis with clearly identifiable ameloblasts, enamel, odontoblasts, and dentin, surrounded by an intact dental sac. Swollen oral mucosal epithelium with associated sebaceous Fordyce nodules, residual ciliated odontogenic epithelium, embryonic epithelial rests, and accessory mucinous and sero-mucinous accessory salivary glands were discovered in place of normal conjunctiva. The tarsus with meibomian glands was absent but islands of cartilage were present.
Because of the variety of the ectopic tissues that were exhibited, a causative displacement of oral embryonic epithelium with extensive differentiating potentialities is posited. Two previously reported palpebral dental choristomas also had identical locations in the inferomedial eyelid. This is the site where the phakomatous choristoma may be encountered, but this unencapsulated mass creates an eyelid thickening without a globoid configuration and infiltrates the inferior orbit. After a careful re-appraisal of published reports of orbital cysts bearing a tooth that were formerly diagnosed as “teratomas,” we have concluded that they developed from similar embryonic oral (buccal) epithelial displacements rather than from aberrant germ cells, based on the cysts' linings and the associated accessory salivary glands in their walls. This view is further supported by the absence of heterologous teratomatous elements of endodermal or neuroectodermal derivation. A clinical and surgical approach to management and a new diagnostic schema for odontogenic choristomas are proposed.
Giant Lacrimal Gland Cyst in a Pediatric Patient: Case Report and Review of the Literature
2023, Ophthalmic Plastic and Reconstructive Surgery
Lacrimal Gland and Nasolacrimal Drainage Apparatus
2023, Imaging Atlas of Ophthalmic Tumors and Diseases

View all citing articles on Scopus

View full text

Clinical pathological reviewLacrimal ductal cysts. Presentation and management

Abstract

Am J Ophthalmol

Am J Ophthalmol

Clinical pathological review
Lacrimal ductal cysts. Presentation and management